Application of pelvic floor dynamic MRI combining defecography with homemade high conformable sacculus in the management of obstructed defecation syndrome / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the sensitivity and feasibility of pelvic floor dynamic MRI combining defecography with homemade high conformable sacculus in the management of obstructed defecation syndrome.</p><p><b>METHODS</b>One hundred and nine female with pelvic floor disorders, such as difficult defecation, fecal incontinence or urinary incontinence, pelvic pain, were treated from July 2007 to March 2009. Pelvic floor dynamic MRI and defecography with homemade high conformable sacculus was performed in the patients to evaluate pelvic floor anatomy.</p><p><b>RESULTS</b>Fifty-four cases (49.6%) of cystocele and 11 cases (10.1%) of rectouterine pouch hernia, 29 cases (26.6%) of perineum prolapse and 71 cases (65.2%) of rectocele were found by dynamic MRI. The dynamic MRI also revealed 19 cases (18.2%) of external sphincter trophy and 32 cases (29.4%) of spastic pelvic floor syndrome. Compared with defecography, dynamic MRI was more positive in diagnosing enterocele. Defecography Of the patients, sacrum-rectal separate was found in 33 cases (30.3%) and rectal mucosal prolapse or internal rectal intussusceptions in 41 cases (37.7%) by defecography, while dynamic MRI found none.</p><p><b>CONCLUSIONS</b>As a new noninvasive imaging technique to evaluate the pelvic floor function, dynamic MRI is more sensitive, especially for patients with complicated multi-organs prolapse, and its deficiency could be remedied by defecography.</p>

Application of stapled transanal rectum resection in the treatment of obstructed defecation syndrome / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness and safety of stapled transanal rectum resection (STARR) in the treatment of obstructed defecation syndrome (ODS).</p><p><b>METHODS</b>Fifty-six patients with ODS who had rectocele and/or intussusception were treated with STARR from January 2007 to August 2008. The incidence of preoperative and postoperative symptoms of ODS was compared. Symptomatic relief was also observed by using scoring system.</p><p><b>RESULTS</b>The average operation time was 28 min, and in the first 3 days after operation the average VAS pain score was 3.2 points. Two patients experienced mild anal incontinence when followed-up to 6 months; 2 patients suffered mild anal pain during defecation due to slight anastomotic inflammation 2 and 4 months after the operation, respectively. No other complications was found. The mean follow-up period was 8 months after surgery, and the rate of symptoms of ODS reduced significantly compared with that before surgery, in particular the incidence of the difficult and obstructive defecation feelings decreased for more than 50 percent (P<0.05). Compared with that before the operation, the sense of no emptying stool decreased for 65 percent and all the other symptoms reduced for more than 72 percent (all P<0.05).</p><p><b>CONCLUSION</b>The stapled transanal rectum resection is simple, less invasive, less painful and with fewer complications and more satisfactory recent effect in treating obstructed defecation syndrome.</p>