AIM: Evaluation of the wide range of normal findings in asymptomatic women undergoing dynamic magnetic resonance (MR) defecography. METHODS: MR defecography of 10 healthy female volunteers (median age: 31 years) witho...AIM: Evaluation of the wide range of normal findings in asymptomatic women undergoing dynamic magnetic resonance (MR) defecography. METHODS: MR defecography of 10 healthy female volunteers (median age: 31 years) without previous pregnancies or history of surgery were evaluated. The rectum was filled with 180 mL gadolinium ultrasound gel mixture. MR defecography was performed in the supine position. The pelvic floor was visualized with a dynamic T2-weighted sagittal plane where all relevant pelvic floor organs were acquired during defecation. The volunteers were instructed to relax and then to perform straining maneuvers to empty the rectum. The pubococcygeal line (PCGL) was used as the line of reference. The movement of pelvic floor organs was measured as the vertical distance to this reference line. Data were recorded in the resting position as well as during the defecation process with maximal straining. Examinations were performed and evaluated by two experienced abdominal radiologists without knowledge of patient history. RESULTS: Average position of the anorectal junction was located at -5.3 mm at rest and -29.9 mm during straining. The anorectal angle widened significantly from 93° at rest to 109° during defecation. A rectocele was diagnosed in eight out of 10 volunteers showing an average diameter of 25.9 mm. The bladder base was located at a position of +23 mm at rest and descended to -8.1 mm during defecation in relation to the PCGL. The bladder base moved below the PCGL in six out of 10 volunteers, which was formally defined as a cystocele. The uterocervical junction was located at an average level of +43.1 mm at rest and at +7.9 mm during straining. The uterocervical junction of three volunteers fell below the PCGL; described formally as uterocervical prolapse. CONCLUSION: Based on the range of standard values in asymptomatic volunteers, MR defecography values for pathological changes have to be re-evaluated.展开更多
Objective:The present study was designed to evaluate the functional outcome of stapled transanal rectal resection(STARR)and to examine the relationship between the population density of the interstitial cells of Cajal...Objective:The present study was designed to evaluate the functional outcome of stapled transanal rectal resection(STARR)and to examine the relationship between the population density of the interstitial cells of Cajal(ICC)and the efficacy of the STARR operation in the management of obstructed defecation syndrome(ODS)patients.Methods:Full-thickness rectal samples were obtained from 50 ODS patients who underwent STARR.Samples were analysed using ICC immunohistochemistry.Clinical and functional parameters obtained with defecography and anorectal manometry were compared with 20 controls.Results:ICCs were significantly decreased in patients in the submucosal(SM),intramuscular(IM)andmyenteric(MY)regions when compared with the control group(P<0.05).The mean pre-operative Cleveland Constipation Score(CCS)was 24.264.1,whilst the CCS at 1,2,3,4 and 5 years post-operatively decreased significantly(P<0.05).At 3 post-operative years,58.3%(28/48)of the patients reported a favorable outcome(CCS10).On univariate analysis,the functional results were worse in those with pre-operative digitation(P=0.017),a decreased ICC-MY cell population(P=0.067),a higher resting anal canal pressure(P=0.039)and a higher rectal sensory threshold(P=0.073).Multivariate analysis showed the decreased ICC-MY cell population was an independent predictor for low unfavorable functional outcome(odds ratio=0.097,95%confidence interval:0.012–0.766).Conclusions:STARR achieved acceptable results at the cost of a slight deterioration over amore prolonged follow-up.Patients with a decreased ICC number in the rectal specimen showed an unfavorable functional outcome where pre-operative histological assessment of a full-thickness rectal samplemight predict for the functional outcome following STARR.展开更多
Background:Surgical management of adult slow-transit constipation(ASTC)can be effective for patients with intractable symptoms.This study aimed to evaluate whether barium-strip examination and selective colectomy impr...Background:Surgical management of adult slow-transit constipation(ASTC)can be effective for patients with intractable symptoms.This study aimed to evaluate whether barium-strip examination and selective colectomy improved post-operative outcomes in ASTC patients in comparison with subtotal colectomy.Methods:A retrospective cohort study of 53 cases with refractory ASTC was conducted between June 2008 and June 2014.Patients were evaluated by the barium-strip technique,colonoscopy,defecography and anorectal manometry.Patients in the standard group underwent laparoscopic subtotal colectomy and patients in the laparoscopic selective colectomy(LSC)group underwent LSC at the precise location identified by barium strip.Spontaneous bowel movements,the Wexner Constipation Scale and the Gastrointestinal Quality of Life Index(GIQLI)were assessed post-operatively at 3,6,12 and 24 months.Results:A total of 49 patients were included in the analysis.The median follow-up was 37 months(range,26–60 months).The mean post-operative hospital stay was 12 days and similar between groups(P=0.071).The length of colon resection,operative time and intra-operative blood loss were reduced in the LSC group(all P<0.05).No major complications occurred.A similar number of patients(24 in the standard group and 25 in the LSC group)exhibited hypoganglionosis or aganglionosis in the colon-wall muscle layer(P=0.986).Although there were no significant differences in post-operative spontaneous bowel movements and the Wexner Constipation Scale between the two groups,the mean GIQLI of the LSC group was significantly higher at 3,6 and 24 months post-operatively(all P<0.05).Conclusions:LSC based on barium-strip examination is an appropriate modality for treating ASTC.展开更多
Introduction:Rectal prolapse is a condition that occurs infrequently in men and there is little literature guiding treatment in this population.The purpose of this study was to evaluate the surgical approach and outco...Introduction:Rectal prolapse is a condition that occurs infrequently in men and there is little literature guiding treatment in this population.The purpose of this study was to evaluate the surgical approach and outcomes of rectal-prolapse repair in men.Methods:A retrospective multicenter review was conducted of consecutive men who underwent rectal-prolapse repair between 2004 and 2014.Surgical approaches and outcomes,including erectile function and fecal continence,were evaluated.Results:During the study period,58 men underwent rectal-prolapse repair and the mean age of repair was 52.7624.1 years.The mean follow-up was 13.2 months(range,0.5–117 months).The majority of patients underwent endoscopic evaluation(78%),but few patients underwent anal manometry(16%),defecography(9%)or ultrasound(3%).Ten patients(17%)underwent biofeedback/pelvic-floor physical therapy prior to repair.Nineteen patients(33%)underwent a perineal approach(most were perineal proctosigmoidectomy).Thirty-nine patients(67%)underwent repair using an abdominal approach(all were suture rectopexy)and,of these,77%were completed using a minimally invasive technique.The overall complication rate was 26%including urinary retention(16%),which was more common in patients undergoing the perineal approach(32%vs.8%,P=0.028),urinary-tract infection(7%)and wound infection(3%).The overall recurrence rate was 9%,with no difference between abdominal and perineal approaches.Information on sexual function was missing in the majority of patients both before and after surgery(76%and 78%,respectively).Conclusion:Rectal-prolapse repair in men is safe and has a low recurrence rate;however,sexual function was poorly recorded across all institutions.Further studies are needed to evaluate to best approach to and functional outcomes of rectal-prolapse repair in men.展开更多
Restorative proctocolectomy with ileal pouch–anal anastomosis has become the surgical treatment of choice for patients with refractory ulcerative colitis,colitis-associated dysplasia or familial adenomatous polyposis...Restorative proctocolectomy with ileal pouch–anal anastomosis has become the surgical treatment of choice for patients with refractory ulcerative colitis,colitis-associated dysplasia or familial adenomatous polyposis.There are various pouch disorders and associated complications.Floppy pouch complex is defined as the presence of pouch prolapse,afferent limb syndrome,enterocele,redundant loop and folding pouch on pouchoscopy,gastrografin pouchogramor defecography.Common clinical presentation includes dyschezia,bloating,abdominal pain,straining or the sense of incomplete evacuation.Each disorder has its own unique endoscopic,radiographic and manometry findings.A range of therapeutic options are available for the management of the various causes of a pouch.展开更多
文摘AIM: Evaluation of the wide range of normal findings in asymptomatic women undergoing dynamic magnetic resonance (MR) defecography. METHODS: MR defecography of 10 healthy female volunteers (median age: 31 years) without previous pregnancies or history of surgery were evaluated. The rectum was filled with 180 mL gadolinium ultrasound gel mixture. MR defecography was performed in the supine position. The pelvic floor was visualized with a dynamic T2-weighted sagittal plane where all relevant pelvic floor organs were acquired during defecation. The volunteers were instructed to relax and then to perform straining maneuvers to empty the rectum. The pubococcygeal line (PCGL) was used as the line of reference. The movement of pelvic floor organs was measured as the vertical distance to this reference line. Data were recorded in the resting position as well as during the defecation process with maximal straining. Examinations were performed and evaluated by two experienced abdominal radiologists without knowledge of patient history. RESULTS: Average position of the anorectal junction was located at -5.3 mm at rest and -29.9 mm during straining. The anorectal angle widened significantly from 93° at rest to 109° during defecation. A rectocele was diagnosed in eight out of 10 volunteers showing an average diameter of 25.9 mm. The bladder base was located at a position of +23 mm at rest and descended to -8.1 mm during defecation in relation to the PCGL. The bladder base moved below the PCGL in six out of 10 volunteers, which was formally defined as a cystocele. The uterocervical junction was located at an average level of +43.1 mm at rest and at +7.9 mm during straining. The uterocervical junction of three volunteers fell below the PCGL; described formally as uterocervical prolapse. CONCLUSION: Based on the range of standard values in asymptomatic volunteers, MR defecography values for pathological changes have to be re-evaluated.
基金supported by the National Natural Science Foundation of China(No.81603628),Medical Scientific Research Foundation of Guangdong Province,China(No.A2015180)and Sun Yat-Sen University Clinical Research 5010 Program(No.2017017).
文摘Objective:The present study was designed to evaluate the functional outcome of stapled transanal rectal resection(STARR)and to examine the relationship between the population density of the interstitial cells of Cajal(ICC)and the efficacy of the STARR operation in the management of obstructed defecation syndrome(ODS)patients.Methods:Full-thickness rectal samples were obtained from 50 ODS patients who underwent STARR.Samples were analysed using ICC immunohistochemistry.Clinical and functional parameters obtained with defecography and anorectal manometry were compared with 20 controls.Results:ICCs were significantly decreased in patients in the submucosal(SM),intramuscular(IM)andmyenteric(MY)regions when compared with the control group(P<0.05).The mean pre-operative Cleveland Constipation Score(CCS)was 24.264.1,whilst the CCS at 1,2,3,4 and 5 years post-operatively decreased significantly(P<0.05).At 3 post-operative years,58.3%(28/48)of the patients reported a favorable outcome(CCS10).On univariate analysis,the functional results were worse in those with pre-operative digitation(P=0.017),a decreased ICC-MY cell population(P=0.067),a higher resting anal canal pressure(P=0.039)and a higher rectal sensory threshold(P=0.073).Multivariate analysis showed the decreased ICC-MY cell population was an independent predictor for low unfavorable functional outcome(odds ratio=0.097,95%confidence interval:0.012–0.766).Conclusions:STARR achieved acceptable results at the cost of a slight deterioration over amore prolonged follow-up.Patients with a decreased ICC number in the rectal specimen showed an unfavorable functional outcome where pre-operative histological assessment of a full-thickness rectal samplemight predict for the functional outcome following STARR.
基金This study was supported by the National Science Foundation of China[No.81700751]the Scientific Research Foundation for the Returned Overseas Chinese Scholars[No.2110000021].
文摘Background:Surgical management of adult slow-transit constipation(ASTC)can be effective for patients with intractable symptoms.This study aimed to evaluate whether barium-strip examination and selective colectomy improved post-operative outcomes in ASTC patients in comparison with subtotal colectomy.Methods:A retrospective cohort study of 53 cases with refractory ASTC was conducted between June 2008 and June 2014.Patients were evaluated by the barium-strip technique,colonoscopy,defecography and anorectal manometry.Patients in the standard group underwent laparoscopic subtotal colectomy and patients in the laparoscopic selective colectomy(LSC)group underwent LSC at the precise location identified by barium strip.Spontaneous bowel movements,the Wexner Constipation Scale and the Gastrointestinal Quality of Life Index(GIQLI)were assessed post-operatively at 3,6,12 and 24 months.Results:A total of 49 patients were included in the analysis.The median follow-up was 37 months(range,26–60 months).The mean post-operative hospital stay was 12 days and similar between groups(P=0.071).The length of colon resection,operative time and intra-operative blood loss were reduced in the LSC group(all P<0.05).No major complications occurred.A similar number of patients(24 in the standard group and 25 in the LSC group)exhibited hypoganglionosis or aganglionosis in the colon-wall muscle layer(P=0.986).Although there were no significant differences in post-operative spontaneous bowel movements and the Wexner Constipation Scale between the two groups,the mean GIQLI of the LSC group was significantly higher at 3,6 and 24 months post-operatively(all P<0.05).Conclusions:LSC based on barium-strip examination is an appropriate modality for treating ASTC.
文摘Introduction:Rectal prolapse is a condition that occurs infrequently in men and there is little literature guiding treatment in this population.The purpose of this study was to evaluate the surgical approach and outcomes of rectal-prolapse repair in men.Methods:A retrospective multicenter review was conducted of consecutive men who underwent rectal-prolapse repair between 2004 and 2014.Surgical approaches and outcomes,including erectile function and fecal continence,were evaluated.Results:During the study period,58 men underwent rectal-prolapse repair and the mean age of repair was 52.7624.1 years.The mean follow-up was 13.2 months(range,0.5–117 months).The majority of patients underwent endoscopic evaluation(78%),but few patients underwent anal manometry(16%),defecography(9%)or ultrasound(3%).Ten patients(17%)underwent biofeedback/pelvic-floor physical therapy prior to repair.Nineteen patients(33%)underwent a perineal approach(most were perineal proctosigmoidectomy).Thirty-nine patients(67%)underwent repair using an abdominal approach(all were suture rectopexy)and,of these,77%were completed using a minimally invasive technique.The overall complication rate was 26%including urinary retention(16%),which was more common in patients undergoing the perineal approach(32%vs.8%,P=0.028),urinary-tract infection(7%)and wound infection(3%).The overall recurrence rate was 9%,with no difference between abdominal and perineal approaches.Information on sexual function was missing in the majority of patients both before and after surgery(76%and 78%,respectively).Conclusion:Rectal-prolapse repair in men is safe and has a low recurrence rate;however,sexual function was poorly recorded across all institutions.Further studies are needed to evaluate to best approach to and functional outcomes of rectal-prolapse repair in men.
基金supported by the Ed and Joey Story Endowed Chair.
文摘Restorative proctocolectomy with ileal pouch–anal anastomosis has become the surgical treatment of choice for patients with refractory ulcerative colitis,colitis-associated dysplasia or familial adenomatous polyposis.There are various pouch disorders and associated complications.Floppy pouch complex is defined as the presence of pouch prolapse,afferent limb syndrome,enterocele,redundant loop and folding pouch on pouchoscopy,gastrografin pouchogramor defecography.Common clinical presentation includes dyschezia,bloating,abdominal pain,straining or the sense of incomplete evacuation.Each disorder has its own unique endoscopic,radiographic and manometry findings.A range of therapeutic options are available for the management of the various causes of a pouch.
