INTRODUCTION: The conventional video colpo-cysto entero defecography describing the morpho- functional imaging features, physiological and pathological of the recto-anal region and pelvic floor . It represents the gold standard examination for the identification and staging of morphological and functional disorders of the recto-anal region and pelvic floor in evacuation dysfunctions. MATERIALS AND METHODS: Between January 2010 to January 2013 88 patients underwent STARR procedure for obstructed defecation syndrome (ODS) caused by single rectocele or internal rectal intussusception. We retrospectively analyzed the collected data,in particular we reviewed the defecography results before surgery. RESULTS: At defecography imaging , 30 patients (34 %) had an anal canal opening between 0 and 5 seconds, 44 (50 %) between 6 and 10 seconds and 14 patients (16 %) over 10 seconds at defecography imaging. The defecography showed an enterocele in 30 patients (34 %) The enterocele was functional in 25 (28,4 %) and stable in 5 (5,6 %) patients. 53 patients have a II° rectocele (60,2 %) and 35 patients a III° rectocele (39,7 %). The average preoperative ODS score was 14 . The average ODS score revaluated at 1 year was 3.1, 4.3 at 3 years an 6,4 after 5 years. The improvement of the ODS score was lower in the subgroup of patients presenting a slow opening of the anal canal (> 10 sec): 7.5 at one year, 9.1 at 3 years and 11 after 5 years follow-up. Also in the subgroup of patients with stable enterocele (5,6 %) the improvement was less evident: 6.7 at 1 year, 8 at 3 years and 9.7 after 5 years follow-up. DISCUSSION AND CONCLUSION: We have observed that a coexistence of a long opening time of the anal canal and / or the presence of a stable enterocele are factors that significantly reduce the effectiveness of the surgery leading over time to ODS score values close to those present before surgery. In the fisrt case we suggest a pre and post-operative perineal physiotherapy, in the second case a Dougla's platsy KEY WORDS: Defecography, Obstructed defecation syndrome, Rectocele, Recto-anal prolapse.

INTRODUZIONE: La colpo-cisto entero defecografia rappresenta oggi il gold standard per l’identificazione e la stadiazione dei disordini morfologici e funzionali della regione retto-anale e del pavimento pelvico nelle sindromi da defecazione ostruita. MATERIALI E METODI: Tra Gennaio 2010 e Gennaio 2013 88 pazienti sono stati sottoposti a procedura di STARR per sindrome da defecazione ostruita (ODS) causata da rettocele e intussuscezione retto-anale. Abbiamo analizzato retrospettivamente i dati raccolti ed in particolare rivisto i risultati defecografici pre-operatori. RISULTATI: 30 pazienti (34%) alla colpo-cisto entero defecografia pre-operatoria, avevano un’apertura del canale anale compresa tra 0 e 5 secondi, 44 (50%) tra 6 e 10 secondi e 14 pazienti (16%) superiore ai 10 secondi. Le immagini hanno mostrato presenza di enterocele in 30 pazienti (34%). In 25 pazienti (28,4%) si trattava di enterocele dinamico, in 5 (5,6%) di enterocele stabile. 53 pazienti avevano un rettocele di II° (60,2%) e 35 pazienti un rettocele di III° (39,7%). I’ ODS score medio preoperatorio era 14. Il punteggio medio di ODS rivalutato a 1 anno è stato di 3,1, 4,3 a 3 anni e 6,4 dopo 5 anni. Il miglioramento del punteggio ODS era inferiore nel sottogruppo di pazienti che presentavano un’apertura lenta del canale anale (> 10 sec): 7,5 a un anno, 9,1 a 3 anni e 11 dopo 5 anni di follow-up. Anche nel sottogruppo di pazienti con enterocele stabile (5,6%) il miglioramento era meno evidente: 6,7 a 1 anno, 8 a 3 anni e 9,7 dopo 5 anni di follow-up. DISCUSSIONE E CONCLUSIONE: I dati ottenuti ci hanno dimostrato che la coesistenza di un lungo periodo di apertura del canale anale e / o la presenza di un enterocele stabile sono fattori che riducono significativamente l’efficacia della chirurgia riducendo il miglioramento dell’ODS score nel breve e lungo periodo. Consigliamo pertanto nel primo caso l’associazione di fisoterapia perineale mentre nel secondo una plastica del cavo del Douglas.

Guttadauro, A., Maternini, M., Ripamonti, L., Pecora, N., Aliprandi, A., Chiarelli, M., et al. (2019). Value of colpo-cysto-entero defecography to predict the post operative results in patients with obstructed defecation. ANNALI ITALIANI DI CHIRURGIA, 90(5), 447-450.

Value of colpo-cysto-entero defecography to predict the post operative results in patients with obstructed defecation

Guttadauro, Angelo
Primo
;
Ripamonti, Lorenzo;Pecora, Nicoletta;
2019

Abstract

INTRODUCTION: The conventional video colpo-cysto entero defecography describing the morpho- functional imaging features, physiological and pathological of the recto-anal region and pelvic floor . It represents the gold standard examination for the identification and staging of morphological and functional disorders of the recto-anal region and pelvic floor in evacuation dysfunctions. MATERIALS AND METHODS: Between January 2010 to January 2013 88 patients underwent STARR procedure for obstructed defecation syndrome (ODS) caused by single rectocele or internal rectal intussusception. We retrospectively analyzed the collected data,in particular we reviewed the defecography results before surgery. RESULTS: At defecography imaging , 30 patients (34 %) had an anal canal opening between 0 and 5 seconds, 44 (50 %) between 6 and 10 seconds and 14 patients (16 %) over 10 seconds at defecography imaging. The defecography showed an enterocele in 30 patients (34 %) The enterocele was functional in 25 (28,4 %) and stable in 5 (5,6 %) patients. 53 patients have a II° rectocele (60,2 %) and 35 patients a III° rectocele (39,7 %). The average preoperative ODS score was 14 . The average ODS score revaluated at 1 year was 3.1, 4.3 at 3 years an 6,4 after 5 years. The improvement of the ODS score was lower in the subgroup of patients presenting a slow opening of the anal canal (> 10 sec): 7.5 at one year, 9.1 at 3 years and 11 after 5 years follow-up. Also in the subgroup of patients with stable enterocele (5,6 %) the improvement was less evident: 6.7 at 1 year, 8 at 3 years and 9.7 after 5 years follow-up. DISCUSSION AND CONCLUSION: We have observed that a coexistence of a long opening time of the anal canal and / or the presence of a stable enterocele are factors that significantly reduce the effectiveness of the surgery leading over time to ODS score values close to those present before surgery. In the fisrt case we suggest a pre and post-operative perineal physiotherapy, in the second case a Dougla's platsy KEY WORDS: Defecography, Obstructed defecation syndrome, Rectocele, Recto-anal prolapse.
Articolo in rivista - Articolo scientifico
Defecography, Obstructed defecation syndrome, Rectocele, Recto-anal prolapse.
English
2019
90
5
447
450
none
Guttadauro, A., Maternini, M., Ripamonti, L., Pecora, N., Aliprandi, A., Chiarelli, M., et al. (2019). Value of colpo-cysto-entero defecography to predict the post operative results in patients with obstructed defecation. ANNALI ITALIANI DI CHIRURGIA, 90(5), 447-450.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/261412
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