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1.
Boccasanta P Venturi M Calabro G Maciocco M Roviaro GC 《Diseases of the colon and rectum》2008,51(3):348-354
Purpose At present, none of the conventional surgical treatments of solitary rectal ulcer associated with internal rectal prolapse
seems to be satisfactory because of the high incidence of recurrence. The stapled transanal rectal resection has been demonstrated
to successfully cure patients with internal rectal prolapse associated with rectocele, or prolapsed hemorrhoids. This prospective
study was designed to evaluate the short-term and long-term results of stapled transanal rectal resection in patients affected
by solitary rectal ulcer associated with internal rectal prolapse and nonresponders to biofeedback therapy.
Methods Fourteen patients were selected on the basis of validated constipation and continence scorings, clinical examination, anorectal
manometry, defecography, and colonoscopy and were submitted to biofeedback therapy. Ten nonresponders were operated on and
followed up with incidence of failure, defined as no improvement of symptoms and/or recurrence of rectal ulceration, as the
primary outcome measure. Operative time, hospital stay, postoperative pain, time to return to normal activity, overall patient
satisfaction index, and presence of residual rectal prolapse also were evaluated.
Results At a mean follow-up of 27.2 (range, 24–34) months, symptoms significantly improved, with 80 percent of excellent/good results
and none of the ten operated patients showed a recurrence of rectal ulcer. Operative time, hospital stay, and time to return
to normal activity were similar to those reported after stapled transanal rectal resection for obstructed defecation, whereas
postoperative pain was slightly higher. One patient complained of perineal abscess, requiring surgery.
Discussion The stapled transanal rectal resection is safe and effective in the cure of solitary rectal ulcer associated with internal
rectal prolapse, with minimal complications and no recurrences after two years. Randomized trials with sufficient number of
patients are necessary to compare the efficacy of stapled transanal rectal resection with the traditional surgical treatments
of this rare condition. 相似文献
2.
Dindo D Weishaupt D Lehmann K Hetzer FH Clavien PA Hahnloser D 《Diseases of the colon and rectum》2008,51(12):1768-1774
Purpose The clinical and morphologic outcome of patients with obstructed defecation syndrome after stapled transanal rectal resection
was prospectively evaluated.
Methods Twenty-four consecutive patients (22 women; median age, 61 (range, 36–74) years) who suffered from obstructed defecation syndrome
and with rectal redundancy on magnetic resonance defecography were enrolled in the study. Constipation was assessed by using
the Cleveland Constipation Score. Morphologic changes were determined by using closed-configuration magnetic resonance defecography
before and after stapled transanal rectal resection.
Results After a median follow-up of 18 (range, 6–36) months, Cleveland Constipation Score significantly decreased from 11 (range,
1–23) preoperatively to 5 (range, 1–15) postoperatively (P = 0.02). In 15 of 20 patients, preexisting intussusception was no longer visible in the magnetic resonance defecography.
Anterior rectoceles were significantly reduced in depth, from 30 mm to 23 mm (P = 0.01), whereas the number of detectable rectoceles did not significantly change. Complications occurred in 6 of the 24
patients; however, only two were severe (1 bleeding and 1 persisting pain requiring reintervention).
Conclusions Clinical improvement of obstructed defecation syndrome after stapled transanal rectal resection correlates well with morphologic
correction of the rectal redundancy, whereas correction of intussusception seems to be of particular importance in patients
with obstructed defecation syndrome.
Presented at Presented at the Congress of the Swiss Surgical Society, Basel, Switzerland, May 28 to 30, 2008. 相似文献
3.
Alfonso Carriero Marcello Picchio Jacopo Martellucci Pasquale Talento Domenico Palimento Erasmo Spaziani 《International journal of colorectal disease》2010,25(3):381-387
Background and aims
We report our experience of concomitant laparoscopic treatment for enterocele and stapled transanal rectal resection (STARR) for rectocele and/or rectal prolapse in patients with complex obstructed defecation syndrome (ODS). 相似文献4.
De Nardi P Corsetti M Passaretti S Squillante S Castellaneta AG Staudacher C Testoni PA 《Diseases of the colon and rectum》2008,51(8):1255-1260
Purpose Stapled hemorrhoidopexy is designed to replace the hemorrhoids into the anal canal by excising the redundant rectal mucosa
above the anorectal ring, thus resulting in an intrarectal suture. Few studies have evaluated rectal function after this procedure.
This prospective study was designed to use the electronic barostat to assess whether rectal motor and sensory functions change
after stapled hemorrhoidopexy.
Methods Ten patients (4 women, mean age, 46 ± 9 years) with third-degree and fourth-degree hemorrhoids who underwent stapled hemorrhoidopexy
were studied. One week before and six months after surgery, they underwent three different rectal distensions (pressure-controlled
stepwise, volume-controlled stepwise, and ramp) controlled by an electronic barostat.
Results Rectal distensibility was significantly lower after surgery during pressure stepwise (P = 0.01), during volume stepwise (P = 0.006), and during ramp distension (P = 0.001). Volume thresholds for desire to defecate, urgency, and discomfort were significantly lower after surgery during
all three distensions (P < 0.05). Volume threshold for first perception also was significantly lower after surgery during volume ramp distension (P = 0.01).
Conclusions Rectal distensibility and volume thresholds for sensations decrease after stapled hemorrhoidopexy. These impairments persist
for at least six months after surgery.
Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6,
2007. 相似文献
5.
M. Pescatori 《coloproctology》2010,32(1):10-22
The procedure for prolapse and hemorrhoids (PPH) and stapled transanal rectal resection for obstructed defecation (STARR) carry low postoperative pain but may be followed by unusual and severe postoperative complications. This review deals with the pathogenesis, prevention, and treatment of adverse events that may occasionally be life threatening. PPH and STARR carry the expected morbidity following anorectal surgery, such as bleeding, strictures, and fecal incontinence. Complications that are particular to these stapled procedures are rectovaginal fistula, chronic proctalgia, total rectal obliteration, rectal wall hematoma, and perforation with pelvic sepsis, often requiring a diverting stoma. A higher complication rate and worse results are expected after PPH for 4th-degree hemorrhoids. Enterocele and anismus are contraindications to PPH and STARR, and both operations should be used with caution in patients with weak sphincters. In conclusion, complications after PPH and STARR are not infrequent and may be difficult to manage. However, if performed in selected cases by skilled specialists aware of the risks and associated diseases, some complications may be prevented. 相似文献
6.
Randomized comparison between stapled hemorrhoidopexy and Ferguson hemorrhoidectomy for grade III hemorrhoids in Taiwan: a prospective study 总被引:1,自引:1,他引:0
Huang WS Chin CC Yeh CH Lin PY Wang JY 《International journal of colorectal disease》2007,22(8):955-961
Purpose Short-term and mid-term outcomes of stapled hemorrhoidopexy (SH) were compared with those for Ferguson hemorrhoidectomy (FH)
for treating hemorrhoids.
Materials and methods Patients with prolapsed hemorrhoids were randomized into two groups treated with SH (N = 300) and FH (N = 296) at Chang Gung Memorial Hospital at Chiayi in Taiwan between January 2002 and December 2004. The outcomes of the procedures
were evaluated postoperatively (short-term, i.e., intra-/postoperative conditions, hospital stay, pain intensity scoring,
time off work, and procedure-related morbidity) and over a follow-up period of minimum 18 months (mid-term, i.e., relapse
of prolapse and/or bleeding, anal stricture, anal sepsis, and the acceptability of the procedures to the patients).
Results SH was superior to FH in operative time, intraoperative blood loss, postoperative pain intensity, and return to work. Based
on telephone interviews over the follow-up period, most patients who received SH appreciated the procedure better than those
with FH.
Conclusions This study confirms that SH generates less postoperative suffering, less time off work, and more complete resolution of primary
symptoms associated with hemorrhoids in the mid-term follow-up than FH. 相似文献
7.
Regadas FS Regadas SM Rodrigues LV Misici R Tramujas I Barreto JB Lins MA Silva FR Filho FS 《Techniques in coloproctology》2005,9(3):243-246
Stapled mucosectomy is widely performed, but in patients with deep gluteal cleft and small distance between the ischial tuberosities,
it is difficult to insert the PPH dilator. We report the results achieved with a new device, the EEA 34–mm circular stapler
(Auto–Suture, New Haven, USA). Eighty–five patients (45 men) were submitted to stapled mucosectomy for treatment of third–
(n=70) or fourth–degree (n=10) hemorrhoids or mucosal prolapse (n=5) by surgeons at four different centers. The patients'
mean age was 53.9 years (range, 45–70 years). ASA Kit (Advanced Surgical Anoscope, Tecplast Company, Fortaleza, Brazil) consists
of four devices: a circular anal dilator (CAD) with anterior and posterior wings, an accessory device for insertion of CAD
into the anal canal, a circular surgical anoscope (CSA) with proximal and distal openings for placing the rectal mucosal purse–string
sutures, and a CSA insertion device. The middle part of the CSA is fully circular in order to avoid that the piles or the
prolapsed mucosa fall into the anoscope. The mean excised mucosal band width was 4.7 cm. The mean operative time was 16 min
(range, 12–25 min). Bleeding from the stapled suture was observed in 10 patients (11.7%). There were 5 postoperative complications
(5.9%): 3 perianal hematomas and 2 stapled suture strictures. Anopexy was considered excellent by the surgeons in 50 patients
(58.8%), good in 25 (29.4%) and poor in 10 (11.7%). At a mean follow–up of 12 months, proctoscopy demonstrated residual asymptomatic
small internal prolapses in 15 patients (17.6%). Full pile prolapses recurred in 2 (2.3%) and required diathermy excision.
ASA Kit made stapled mucosectomy easier to perform, but it's necessary to improve the circular staplers to adequately treat
all sizes of mucosal and hemorrhoidal prolapses in order to reduce the recurrence rates. 相似文献
8.
Ito M Sugito M Kobayashi A Nishizawa Y Tsunoda Y Saito N 《International journal of colorectal disease》2008,23(7):703-707
Background We experienced some technical difficulty in dividing the middle and lower rectum through the right-lower quadrant intracorporeally.
The aim of this study was to determine whether multiple stapler firings during rectal division are associated with anastomotic
leakage after laparoscopic rectal resection.
Methods Laparoscopic anterior resection with double-stapling technique anastomosis was performed in 180 consecutive rectal cancer
patients. We often used vertical rectal division through a suprapubic site instead of the standard transverse rectal division
for laparoscopic total mesorectal excision (LapTME). We attempted to determine whether there was an association between the
number of stapler firings and procedures in rectal division. Moreover, we identified risk factors for anastomotic leakage
after laparoscopic rectal resection by multivariate analysis.
Results Anastomotic leakage occurred in 5% of the subjects of this study. Vertical rectal division through the suprapubic site after
Lap TME required fewer staples than transverse division through the right-lower port and a smaller percentage of patients
required three or more staples for vertical rectal division than for transverse division (15% vs. 45%, p = 0.03). In the multivariate analysis, TME and the number of staplers used for rectal division were the factors found to
be associated with a significantly greater risk of subsequent leakage (odd’s ratio = 5.3; 95% CI 1.2–22.7 and odd’s ratio = 4.6;
95% CI 1.1–19.2).
Conclusion TME and multiple stapler firings during distal rectal division were associated with anastomotic leakage after laparoscopic
rectal resection. Vertical rectal division through a suprapubic site was a useful method of avoiding multiple stapler firings
during laparoscopic TME. 相似文献
9.
Yun HR Lee LJ Park JH Cho YK Cho YB Lee WY Kim HC Chun HK Yun SH 《International journal of colorectal disease》2008,23(11):1081-1087
Background and aims There are a range of rates and a number of prognostic factors associated with the local recurrence of colorectal cancer after
curative resection. The aim of this study was to identify the potential prognostic factors of local recurrence in patients
with colon and rectal cancers.
Materials and methods A retrospective review of 1,838 patients who underwent curative resection of non-metastatic colorectal cancer was conducted.
The patients were treated between 1994 and 2004, and had a minimum follow-up of 3 years.
Results There were 994 patients with colon cancer and 844 patients with rectal cancer. The median duration of follow-up was 60.9 ± 24.5 months.
With respect to colon cancer, the local recurrence rate was 6.1% (61 patients). With respect to rectal cancer, 95 patients
had a local recurrence (11.3%), the rate of which was statistically greater than the local recurrence rate for colon cancer
(p < 0.001). The overall recurrence rate was 16.4% (301 patients), and the local recurrence rate, with or without systemic metastases,
was 8.5% (156 patients). Local recurrences occurred within 2 and 3 years in 59.9% and 82.4% of the patients, respectively.
In patients with colon and rectal cancer, the pathologic T stage (p = 0.044 and p = 0.034, respectively), pathologic N stage (p = 0.001 and p < 0.001, respectively), and lymphovascular invasion (p = 0.013 and p = 0.004, respectively) were adverse risk factors for local recurrence. The level of the anastomosis from the anal verge was
an additional prognostic factor (p = 0.007) in patients with rectal cancer.
Conclusion Compulsive follow-up care of patients with colon and rectal cancers is needed for 3 years after curative resection, especially
in patients who have adverse risk factors for local recurrence. 相似文献
10.
Purpose The procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy) has been introduced as an alternative to conventional
hemorrhoidectomy. This is a systematic review on stapled hemorrhoidopexy of all randomized, controlled trials that have been
published until August 2006.
Methods All published, randomized, controlled trials comparing stapled hemorrhoidopexy to conventional hemorrhoidectomy were identified
from Ovid MEDLINE, EMBASE, CINAHL, and all Evidence-Based Medicine Reviews (Cochrane Central Register of Controlled Trial,
Cochrane Database of Systemic Review, and Database of Abstracts of Reviews of Effects) between January 1991 and August 2006.
Meta-analysis was performed by using the Forest plot review if feasible.
Results A total of 25 randomized, controlled trials with 1,918 procedures were reviewed. The follow-up duration was from 1 to 62 months.
Stapled hemorrhoidopexy was associated with less operating time (weighted mean difference, −11.35 minutes; P = 0.006), earlier return of bowel function (weighted mean difference −9.91 hours; P < 0.00001), and shorter hospital stay (weighted mean difference, −1.07 days; P = 0.0004). There was less pain after stapled hemorrhoidopexy, as evidenced by lower pain scores at rest and on defecation
and 37.6 percent reduction in analgesic requirement. The stapled hemorrhoidopexy allowed a faster functional recovery with
shorter time off work (weighted mean difference, −8.45 days; P < 0.00001), earlier return to normal activities (weighted mean difference, −15.85 days; P = 0.03), and better wound healing (odds ratio, 0.1; P = 0.0006). The patients’ satisfaction was significantly higher with stapled hemorrhoidopexy than conventional hemorrhoidectomy
(odds ratio, 2.33; P = 0.003). Although there was increase in the recurrence of hemorrhoids at one year or more after stapled procedure (5.7 vs. 1 percent; odds ratio, 3.48; P = 0.02), the overall incidence of recurrent hemorrhoidal symptoms—early (fewer than 6 months; stapled vs. conventional: 24.8 vs. 31.7 percent; P = 0.08) or late (1 year or more) recurrence rate (stapled vs. conventional: 25.3 vs. 18.7 percent; P = 0.07)—was similar. The overall complication rate did not differ significantly from that of conventional procedure (stapled
vs. conventional: 20.2 vs. 25.2 percent; P = 0.06). Compared with conventional surgery, stapled hemorrhoidopexy has less postoperative bleeding (odds ratio, 0.52; P = 0.001), wound complication (odds ratio, 0.05; P = 0.005), constipation (odds ratio, 0.45; P = 0.02), and pruritus (odds ratio, 0.19; P = 0.02). The overall need of surgical (odds ratio, 1.27; P = 0.4) and nonsurgical (odds ratio, 1.07; P = 0.82) reintervention after the two procedures was similar.
Conclusions The Procedure for Prolapse and Hemorrhoid (stapled hemorrhoidopexy) is safe with many short-term benefits. The long-term results
are similar to conventional procedure.
Read at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 3 to 7, 2006. 相似文献
11.
Biviano I Badiali D Candeloro L Habib FI Mongardini M Caviglia A Anzini F Corazziari ES 《World journal of gastroenterology : WJG》2011,17(37):4199-4205
AIM:To prospectively assess the eff icacy and safety of stapled trans-anal rectal resection(STARR) compared to standard conservative treatment,and whether preoperative symptoms and findings at defecography and anorectal manometry can predict the outcome of STARR.METHODS:Thirty patients(Female,28;age:51 ± 9 years) with rectocele or rectal intussusception,a defecation disorder,and functional constipation were submitted for STARR.Thirty comparable patients(Female,30;age 53 ± 13 years),who presented with sympto... 相似文献
12.
Procedure for prolapsing hemorrhoids (PPH) and stapled transanal rectal resection for obstructed defecation (STARR) carry low postoperative pain, but may be followed by unusual and severe postoperative complications. This review deals with the pathogenesis, prevention and treatment of adverse events that may occasionally be life threatening. PPH and STARR carry the expected morbidity following anorectal surgery, such as bleeding, strictures and fecal incontinence. Complications that are particular to these stapled procedures are rectovaginal fistula, chronic proctalgia, total rectal obliteration, rectal wall hematoma and perforation with pelvic sepsis often requiring a diverting stoma. A higher complication rate and worse results are expected after PPH for fourth-degree piles. Enterocele and anismus are contraindications to PPH and STARR and both operations should be used with caution in patients with weak sphincters. In conclusion, complications after PPH and STARR are not infrequent and may be difficult to manage. However, if performed in selected cases by skilled specialists aware of the risks and associated diseases, some complications may be prevented. 相似文献
13.
McMillan DC Crozier JE Canna K Angerson WJ McArdle CS 《International journal of colorectal disease》2007,22(8):881-886
Background/aims The aim of the study was to examine the value of the combination of an elevated C-reactive protein and hypoalbuminaemia (GPS)
in predicting cancer-specific survival after resection for colon and rectal cancer.
Materials and methods The GPS was constructed as follows: Patients with both an elevated C-reactive protein (>10 mg/l) and hypoalbuminaemia (<35 g/l)
were allocated a score of 2. Patients in whom only one or none of these biochemical abnormalities was present were allocated
a score of 1 or 0, respectively.
Results A GPS of 1 (n = 109) was mainly due to an elevated C-reactive protein concentration and the remainder due to hypoalbuminaemia. In those
patients with a GPS of 1 due to hypoalbuminaemia (n = 16), the 3-year overall survival rate was 94% compared with 62% in those patients with a GPS of 1 due to an elevated C-reactive
protein concentration (n = 93, p = 0.0094). Therefore, the GPS was modified such that patients with hypoalbuminaemia were assigned a score of 0 in the absence
of an elevated C-reactive protein. On univariate analysis of those patients with colon and rectal cancer, the modified GPS
(p < 0.0001) was significantly associated with overall and cancer specific survival. On univariate survival analysis of those
patients with Dukes B colon and rectal cancer, the modified GPS (p < 0.01) was significantly associated with overall and cancer specific survival.
Conclusion The results of the present study indicate that the GPS, before surgery, predicts overall and cancer-specific survival after
resection of colon and rectal cancer. 相似文献
14.
The Contour® Transtar? operation represents a further methodological development of conventional transanal stapled rectal resection (STARR) for the treatment of obstructed defecation syndrome (ODS) and/or full thickness rectal prolapse. In contrast to the conventional STARR technique a specially designed single curved stapler is used with which the rectal wall is incised in a circular fashion and anastomosed. This results in a monoblock resection with almost unlimited extent of resection. In multicenter studies the procedure has generally been shown to be effective for treatment of ODS with intussusception and rectocele. In comparison to conventional STARR the resected tissue samples are larger and the functional effectiveness is comparable. Furthermore, data from prospective randomized trials revealed higher effectiveness in long-term follow-up. With reference to full thickness rectal prolapse, feasibility studies have been performed which showed low morbidity but long-term follow-up studies suggest a high recurrence rate of >40?%. 相似文献
15.
Lehur PA Stuto A Fantoli M Villani RD Queralto M Lazorthes F Hershman M Carriero A Pigot F Meurette G Narisetty P Narisetty P Villet R;ODS II Study Group 《Diseases of the colon and rectum》2008,51(11):1611-1618
Purpose This study was designed to assess the safety and outcomes achieved with stapled transanal rectal resection vs. biofeedback training in obstructed defecation patients.
Methods A total of 119 women patients who suffered from obstructed defecation with associated rectocele and rectal intussusception
were randomized to stapled transanal rectal resection or biofeedback training. Stapled transanal rectal resection was performed
by using two circular staplers to produce transanal full-thickness rectal resection. Primary outcome was symptoms of obstructed
defecation resolution at 12 months; secondary outcomes included safety, change in quality of life score, and anatomic correction
of rectocele and rectal intussusception.
Results Fourteen percent (8/59) stapled transanal rectal resection and 50 percent (30/60) biofeedback training patients withdrew early.
Eight (15 percent) patients treated with stapled transanal rectal resection and 1 (2 percent) biofeedback patient experienced
adverse events. One serious adverse event (bleeding) occurred after stapled transanal rectal resection. Scores of obstructed
defecation improved significantly in both groups as did quality of life (both P < 0.0001). Successful treatment was observed in 44 (81.5 percent) stapled transanal rectal resection vs. 13 (33.3 percent) evaluable biofeedback training patients (P < 0.0001). Functional benefit was observed early and remained stable during the study.
Conclusions In this controlled trial, stapled transanal rectal resection was well tolerated, was more effective than biofeedback training
for the resolution of obstructed defecation symptoms, and improved quality of life, with minimal risk of impaired continence.
Thus, stapled transanal rectal resection offers a new treatment alternative for obstructed defecation after failure of conservative
measures including biofeedback training, a noninvasive approach.
Supported by grants from Ethicon Endo-Surgery (Europe) GmbH, Norderstedt, Germany.
Presented at the meeting of the European Society of Colo-Proctology (ESCP), Malta, September 26 to 29, 2007.
An erratum to this article can be found at 相似文献
16.
Purpose The purpose of this systematic review was to compare the long-term results of stapled hemorrhoidopexy with conventional excisional
hemorrhoidectomy in patients with internal hemorrhoids.
Methods A systematic review of all randomized, controlled trials comparing stapled hemorrhoidopexy and conventional hemorrhoidectomy
with long-term results was performed by using the Cochrane methodology. The minimum follow-up was six months. Primary outcomes
were hemorrhoid recurrence, hemorrhoid symptom recurrence, complications, and pain.
Results Twelve trials were included. Follow-up varied from six months to four years. Conventional hemorrhoidectomy was more effective
in preventing long-term recurrence of hemorrhoids (odds ratio (OR), 3.85; 95 percent confidence interval (CI), 1.47–10.07;
P < 0.006). Conventional hemorrhoidectomy also prevents hemorrhoids in studies with follow-up of one year or more (OR, 3.6;
95 percent CI, 1.24–10.49; P < 0.02). Conventional hemorrhoidectomy is superior in preventing the symptom of prolapse (OR, 2.96; 95 percent CI, 1.33–6.58;
P < 0.008). Conventional hemorrhoidectomy also is more effective at preventing prolapse in studies with follow-up of one year
or more (OR, 2.68; 95 percent CI, 0.98–7.34; P < 0.05). Nonsignificant trends in favor of conventional hemorrhoidectomy were seen in the proportion of asymptomatic patients,
bleeding, soiling/difficultly with hygiene/incontinence, the presence of perianal skin tags, and the need for further surgery.
Nonsignificant trends in favor of stapled hemorrhoidopexy were seen in pain, pruritus ani, and symptoms of anal obstruction/stenosis.
Conclusions Conventional hemorrhoidectomy is superior to stapled hemorrhoidopexy for prevention of postoperative recurrence of internal
hemorrhoids. Fewer patients who received conventional hemorrhoidectomy complained of hemorrhoidal prolapse in long-term follow-up
compared with stapled hemorrhoidopexy.
Podium presentations at the Canadian Surgical Forum, Montreal, Quebec, Canada, September 8 to 11, 2005, and the Tripartite
Colorectal Meeting, Dublin, Ireland, July 5 to 7, 2005.
This paper is based on a Cochrane Review published in The Cochrane Library 2006, Issue 4. Cochrane Reviews are regularly updated
as new evidence emerges and in response to feedback, The Cochrane Library should be consulted for the most recent version
of the review. 相似文献
17.
Klaver YL Nienhuijs SW Nieuwenhuijzen GA Rutten HJ de Hingh IH 《International journal of colorectal disease》2008,23(2):165-169
Backgrounds and aim Omentoplasty is frequently used as a safeguard in rectal cancer surgery for wrapping the anastomosis or filling up the pelvic
cavity. The omentum is known for its infection defence and haemostatic and angiogenic properties. A disadvantage was hypothesized
to be prolonged post-operative ileus, as omentoplasty interrupts the blood flow from an epiploic artery to the stomach.
Materials and methods Patients who had had an uncomplicated surgical treatment for primary rectal cancer between January 2006 and March 2007 were
included. Clinical parameters of post-operative ileus were collected and compared between procedures with a concomitant omentoplasty
(n = 31) and without (n = 20).
Results Patients needed their gastric tube significantly longer after omentoplasty than those without (3.9 vs 1.6 days, p < 0.001). Similar significant results were found for time to normal diet (p = 0.004), time to first discharge of faeces (p = 0.007), need for parenteral feeding (p = 0.036) and length of hospital stay (p = 0.008). Furthermore, there was a non-significant trend for more days to first discharge of air (3.4 vs 2.4 days, p = 0.165). There were no significant differences in patients’ and procedure characteristics, except for more low anterior
resections in the group without an omentoplasty (p < 0.001). None of these characteristics had any clinically relevant interference with the parameters of post-operative ileus.
Conclusion A trend for prolonged post-operative ileus was found in patients who underwent an omentoplasty concomitant with their treatment
for primary rectal cancer. When assessing the importance of omentoplasty in the future, post-operative ileus should be taken
into account. 相似文献
18.
We report a case of rectal diverticulum developed after stapled transanal rectal resection (STARR) procedure for obstructed defecation. A 21-year-old woman with chronic constipation was diagnosed with a rectocele at defecography. The patient underwent STARR procedure. Six months later, she presented with severe constipation requiring enemas and a worse condition than that preoperatively. Defecography and rectoscopy revealed a rectal wall diverticulum cavity with incomplete elimination of barium enema. The patient underwent transanal diverticulectomy and direct rectal wall repair. STARR procedure can produce new and difficult-to-treat complications and should be reserved for expert colorectal surgeons with proved familiarity in transanal surgery. 相似文献
19.
目的评估经肛吻合器直肠部分切除术治疗重度脱垂性痔病的安全性及有效性。
方法2013年10月至2015年4月,运用经肛吻合器直肠部分切除术治疗重度脱垂性痔病48例。记录所有患者手术相关指标、围手术期并发症、住院时间及患者满意度,判断总疗效。
结果48例患者全部顺利完成手术,手术时间平均23.5 min;切除标本宽度平均4.8 cm、体积9.6 ml;26例术中吻合口出血行跨吻合口"8"字缝扎,平均缝扎1.7个点。术后17例出现排尿障碍,其中11例予以药物口服,6例留置导尿。术后当日疼痛评分2.5分,首次排便疼痛评分3.8分;肛门坠胀感评分2.9分;肛门控便功能,术后7天,CCF-FIS评分平均2.3分。住院时间平均7.2天。术后6个月患者满意度9.8分;随访31.3个月,无痔核脱出发生,总有效率100%。
结论经肛吻合器直肠部分切除术治疗重度脱垂性痔病是安全、有效的。 相似文献
20.
Background Dynamic three-dimensional computed tomography (D-3DCT: high-speed helical scanning during defecation) was used for morphological
evaluation of intrapelvic structures in patients with rectal prolapse and rectocele.
Methods Twenty-five patients with rectal prolapse or rectocele diagnosed by conventional defecography (CD) or clinical findings were
additionally investigated with D-3DCT. D-3DCT images were acquired using a multislice CT system with a 16-row detector during
simulated defecation. Helical scanning was performed with a slice thickness of 1 mm, a helical pitch of 15 s/rotation, and
a table movement speed of 35 mm/s. The contrast medium, 100 ml of iopamidol (370 mg/ml), was injected at a rate of 2.5 ml/s
to enhance contrast with other structures, and scan start was triggered by using a function for automatically determining
the optimal scan timing.
Results Among the eight patients with rectocele, additional intrapelvic disorders were diagnosed in five (enterocele, 4; cystocele,
1; and uterine prolapse, 1) with D-3DCT. In the 17 patients with rectal prolapse, concomitant intrapelvic disorders were found
in six (intussusception, 3; cystocele, 2; uterine prolapse, 2; rectocele, 1; and vaginal prolapse, 1).
Conclusions D-3DCT can be a useful diagnostic tool for investigation of pelvic pathology in patients with rectocele and rectal prolapse. 相似文献