D F Altomare1, A Picciariello2, R Memeo2, M Fanelli3, R Digennaro2, N Chetta2, M De Fazio2. 1. Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Disease (CIRPAP), University Aldo Moro of Bari, Piazza G Cesare 11, 70124, Bari, Italy. donatofrancesco.altomare@uniba.it. 2. Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Disease (CIRPAP), University Aldo Moro of Bari, Piazza G Cesare 11, 70124, Bari, Italy. 3. Nuclear Medicine Unit, D.I.M. University Aldo Moro of Bari, Bari, Italy.
Abstract
BACKGROUND: Obstructed defecation syndrome (ODS), most commonly found in females, can be treated by a transanal or abdominal approach with good success rate. Nevertheless, patients may experience de novo or persisting pelvic floor dysfunctions after surgery. The aim of this study was to compare the functional outcome of stapled transanal rectal resection (STARR) and ventral rectopexy (VRP) in a series of ODS patients. METHODS: Forty-nine female patients who had surgery for ODS between 2006 and 2016 were retrospectively evaluated: 28 (median age 60 years, IQR 54-69 years) had VRP and 21 (median age 58 years, IQR 51-66 years) had STARR. ODS was scored with the ODS score while the overall pelvic floor function was assessed with the three axial perineal evaluation (TAPE) score. Quality-of-life was evaluated by the patient assessment of constipation quality-of-life (PAC-Qol) questionnaire administered preoperatively and after 1 year of follow-up. RESULTS: The preoperative median ODS score and TAPE score were comparable in both groups. After a median follow-up of 12 months (range 12-18 months), the median ODS score was 12 (range 10-20) in the STARR group and 9 (range 3-15) in the VRP one (p = 0.02), while the median TAPE score was 70.5 (IQR 60.6-77.3) in the former and 76.8 (IQR 70.2-89.7) in the latter (p = 0.01). Postoperatively the physical domain of the PAC-QoL score had a median value of 2.74 (IQR 1.7-3.75) in the STARR group compared to 1.5 (IQR 1-2.5) in the VRP group (p = 0.03). No major complications were recorded in either group. CONCLUSIONS: VRP and STARR can improve defecation in patients with ODS with minimal complications, but the overall pelvic wellness evaluated by the TAPE score improves significantly only after VRP, suggesting a better performance of VRP than STARR when overall pelvic floor function is concerned.
BACKGROUND:Obstructed defecation syndrome (ODS), most commonly found in females, can be treated by a transanal or abdominal approach with good success rate. Nevertheless, patients may experience de novo or persisting pelvic floor dysfunctions after surgery. The aim of this study was to compare the functional outcome of stapled transanal rectal resection (STARR) and ventral rectopexy (VRP) in a series of ODS patients. METHODS: Forty-nine female patients who had surgery for ODS between 2006 and 2016 were retrospectively evaluated: 28 (median age 60 years, IQR 54-69 years) had VRP and 21 (median age 58 years, IQR 51-66 years) had STARR. ODS was scored with the ODS score while the overall pelvic floor function was assessed with the three axial perineal evaluation (TAPE) score. Quality-of-life was evaluated by the patient assessment of constipation quality-of-life (PAC-Qol) questionnaire administered preoperatively and after 1 year of follow-up. RESULTS: The preoperative median ODS score and TAPE score were comparable in both groups. After a median follow-up of 12 months (range 12-18 months), the median ODS score was 12 (range 10-20) in the STARR group and 9 (range 3-15) in the VRP one (p = 0.02), while the median TAPE score was 70.5 (IQR 60.6-77.3) in the former and 76.8 (IQR 70.2-89.7) in the latter (p = 0.01). Postoperatively the physical domain of the PAC-QoL score had a median value of 2.74 (IQR 1.7-3.75) in the STARR group compared to 1.5 (IQR 1-2.5) in the VRP group (p = 0.03). No major complications were recorded in either group. CONCLUSIONS:VRP and STARR can improve defecation in patients with ODS with minimal complications, but the overall pelvic wellness evaluated by the TAPE score improves significantly only after VRP, suggesting a better performance of VRP than STARR when overall pelvic floor function is concerned.
Entities:
Keywords:
Constipation; Defecation; Digestive system surgical procedures; Pelvic floor; Quality of life; STARR; Surgical stapling
Authors: Giuseppe Gagliardi; Mario Pescatori; Donato F Altomare; Gian Andrea Binda; Corrado Bottini; Giuseppe Dodi; Vincenzino Filingeri; Giovanni Milito; Marcella Rinaldi; Giovanni Romano; Liana Spazzafumo; Mario Trompetto Journal: Dis Colon Rectum Date: 2007-12-22 Impact factor: 4.585
Authors: Isabelle Ma van Gruting; Aleksandra Stankiewicz; Ranee Thakar; Giulio A Santoro; Joanna IntHout; Abdul H Sultan Journal: Cochrane Database Syst Rev Date: 2021-09-23
Authors: Lorenzo Ripamonti; Angelo Guttadauro; Giulia Lo Bianco; Maria Rennis; Matteo Maternini; Gerardo Cioffi; Marco Chiarelli; Matilde De Simone; Ugo Cioffi; Francesco Gabrielli Journal: Front Surg Date: 2022-02-14