Background: Constipation and encopresis frequently cause problems with respect to emotional wellbeing, and social and family life.Instruments to measure Health Related Quality of Life (HRQoL) in these disorders ill ar...Background: Constipation and encopresis frequently cause problems with respect to emotional wellbeing, and social and family life.Instruments to measure Health Related Quality of Life (HRQoL) in these disorders ill are not available.Methods: Adisease specific HRQoL instrument, the "Defecation Disorder List"(DDL) for children with constipation or functional non-retentive faecal soiling (FNRFS) was developed using accepted guidelines.For each phase of the process, different samples of patients were used.The final phase of development included 27 children.Reliability was assessed in two ways: internal consistency of domains with Cronbach’s alpha, and test-retest reliability with intra-class correlation coefficients (ICC).To assess validity, comparable items and domains were correlated with Tacqol, a generic HRQoL instrument for children (TNOAZL).Results: In the final phase of the development, 27 children completed the instrument.It consisted of 37 items in four domains.The response rate was 96%.Reliability was good for all domains, with Cronbach’s alpha values ranging from 0.61 to 0.76.Measures of test-retest stability were good for all four domains with ICCs ranging from 0.82 to 0.92.Validity based on comparison with the Tacqol instrument was moderate.Conclusion: The DDL is promising as a measure of HRQoL in childhood defecation disorders.展开更多
PURPOSE: This study was designed to evaluate the safety, efficacy, and impact on quality of life of the perineal puborectalis sling operation for fecal incontinence. METHODS: Since August 2001, we performed the perine...PURPOSE: This study was designed to evaluate the safety, efficacy, and impact on quality of life of the perineal puborectalis sling operation for fecal incontinence. METHODS: Since August 2001, we performed the perineal puborectalis sling operation on eight patients with idiopathic fecal incontinence. A specially designed polyester mesh sling was introduced along the puborectalis muscle, from a posterior perianal incision, running to a small suprapubic incision. The ends were tied together with moderate tension. Patients were evaluated with the Fecal Incontinence Severity Index, the Cleveland Clinic Score of Incontinence, and the Fecal Incontinence Quality of Life Scale. Manometry and defecography were performed before and six months after the operation. RESULTS: Eight patients (7 females; mean age, 63 (range, 44-77) years) were evaluated. A wound infection developed in one patient, which subsided with antibiotics. A rectal ulcer developed in one patient, necessitating sling removal. In the remaining seven patients, the Fecal Incontinence Severity Index improved from 27 to 9, and the Cleveland Clinic Score of Incontinence improved from 13 to 5 (P < 0.05). All parameters in the Fecal Incontinence Quality of Life Scale improved: lifestyle from 2.1 to 3.6; coping/behavior from 1.5 to 3.4; depression/self perception from 2.3 to 3.7; and embarrassment from 2 to 3.6 (P < 0.05). No significant difference was found between preoperative and postoperative maximum resting pressure and maximum squeeze pressure. However, the median anorectal angle on defecography after the operation was significantly reduced (P < 0.05). CONCLUSIONS: We believe that the perineal puborectalis sling operation is technically feasible, with low morbidity, and can be an effective procedure for idiopathic fecal incontinence.展开更多
Background/Purpose Laparoscopically assisted endorectal pull-through (EPT) vi a a perineal approach using a prolapsing technique (PA) for Hirschsprung’s dise ase (HD) has been reported. However, the clinical outcome ...Background/Purpose Laparoscopically assisted endorectal pull-through (EPT) vi a a perineal approach using a prolapsing technique (PA) for Hirschsprung’s dise ase (HD) has been reported. However, the clinical outcome after this approach ha s not been reported. The purpose of this study was to compare the clinical outco me of PA and the conventional transabdominal approach (TA). Methods In the perio d between 1990 and 2001, 20 cases of HD underwent EPT with TA (group O), and 21 underwent EPT with PA (group L). There was no difference in age and weight distr ibution between the 2 groups. Clinical outcome was assessed 3 years after surger y. Results The operation time was comparable in the 2 groups (4.9 ±0.8 v 5.2 ±0.8 hr), whereas blood loss (98 ±52 v 36 ±30 mL) and postoperative complic ations requiring surgical intervention (26%v 0%) were significantly lower in g roup L. The incidence of postoperative enteritis (27%v 28%) and voluntary defe cation (more than once every/2 days) were compatible in the 2 groups (70%v 87% ). Soiling (small amount of involuntary stooling; > 1 per month)was significantl y less frequent in group L (45%v 14%). Conclusions Laparoscopically assisted E TP with PA is less invasive and can provide a better clinical outcome compared w ith TA in terms of postoperative soiling.展开更多
文摘Background: Constipation and encopresis frequently cause problems with respect to emotional wellbeing, and social and family life.Instruments to measure Health Related Quality of Life (HRQoL) in these disorders ill are not available.Methods: Adisease specific HRQoL instrument, the "Defecation Disorder List"(DDL) for children with constipation or functional non-retentive faecal soiling (FNRFS) was developed using accepted guidelines.For each phase of the process, different samples of patients were used.The final phase of development included 27 children.Reliability was assessed in two ways: internal consistency of domains with Cronbach’s alpha, and test-retest reliability with intra-class correlation coefficients (ICC).To assess validity, comparable items and domains were correlated with Tacqol, a generic HRQoL instrument for children (TNOAZL).Results: In the final phase of the development, 27 children completed the instrument.It consisted of 37 items in four domains.The response rate was 96%.Reliability was good for all domains, with Cronbach’s alpha values ranging from 0.61 to 0.76.Measures of test-retest stability were good for all four domains with ICCs ranging from 0.82 to 0.92.Validity based on comparison with the Tacqol instrument was moderate.Conclusion: The DDL is promising as a measure of HRQoL in childhood defecation disorders.
文摘PURPOSE: This study was designed to evaluate the safety, efficacy, and impact on quality of life of the perineal puborectalis sling operation for fecal incontinence. METHODS: Since August 2001, we performed the perineal puborectalis sling operation on eight patients with idiopathic fecal incontinence. A specially designed polyester mesh sling was introduced along the puborectalis muscle, from a posterior perianal incision, running to a small suprapubic incision. The ends were tied together with moderate tension. Patients were evaluated with the Fecal Incontinence Severity Index, the Cleveland Clinic Score of Incontinence, and the Fecal Incontinence Quality of Life Scale. Manometry and defecography were performed before and six months after the operation. RESULTS: Eight patients (7 females; mean age, 63 (range, 44-77) years) were evaluated. A wound infection developed in one patient, which subsided with antibiotics. A rectal ulcer developed in one patient, necessitating sling removal. In the remaining seven patients, the Fecal Incontinence Severity Index improved from 27 to 9, and the Cleveland Clinic Score of Incontinence improved from 13 to 5 (P < 0.05). All parameters in the Fecal Incontinence Quality of Life Scale improved: lifestyle from 2.1 to 3.6; coping/behavior from 1.5 to 3.4; depression/self perception from 2.3 to 3.7; and embarrassment from 2 to 3.6 (P < 0.05). No significant difference was found between preoperative and postoperative maximum resting pressure and maximum squeeze pressure. However, the median anorectal angle on defecography after the operation was significantly reduced (P < 0.05). CONCLUSIONS: We believe that the perineal puborectalis sling operation is technically feasible, with low morbidity, and can be an effective procedure for idiopathic fecal incontinence.
文摘Background/Purpose Laparoscopically assisted endorectal pull-through (EPT) vi a a perineal approach using a prolapsing technique (PA) for Hirschsprung’s dise ase (HD) has been reported. However, the clinical outcome after this approach ha s not been reported. The purpose of this study was to compare the clinical outco me of PA and the conventional transabdominal approach (TA). Methods In the perio d between 1990 and 2001, 20 cases of HD underwent EPT with TA (group O), and 21 underwent EPT with PA (group L). There was no difference in age and weight distr ibution between the 2 groups. Clinical outcome was assessed 3 years after surger y. Results The operation time was comparable in the 2 groups (4.9 ±0.8 v 5.2 ±0.8 hr), whereas blood loss (98 ±52 v 36 ±30 mL) and postoperative complic ations requiring surgical intervention (26%v 0%) were significantly lower in g roup L. The incidence of postoperative enteritis (27%v 28%) and voluntary defe cation (more than once every/2 days) were compatible in the 2 groups (70%v 87% ). Soiling (small amount of involuntary stooling; > 1 per month)was significantl y less frequent in group L (45%v 14%). Conclusions Laparoscopically assisted E TP with PA is less invasive and can provide a better clinical outcome compared w ith TA in terms of postoperative soiling.
