ABSTRACT
BACKGROUND: Transcutaneous sacral nerve stimulation is reported to improve symptoms of fecal incontinence. Chronic constipation may also respond to stimulation, but this is poorly reported in the literature. OBJECTIVE: The study assessed the efficacy of transcutaneous electrical stimulation directly over the sacral nerve roots in chronic constipation. PATIENTS: Chronic functional constipation was established in all patients using the Rome III criteria. SETTING: The therapy was self-administered at home. DESIGN/INTERVENTION: A pilot study was conducted of transcutaneous sacral stimulation given over a 4-week period for 12 hours a day. MAIN OUTCOME MEASURES: Patients were assessed using the Patient Assessment of Constipation Symptoms, the Patient Assessment of Constipation Quality of Life, and the Cleveland constipation tool. A Global Rating of Change measure and a 1-week bowel diary was kept for the final week and compared with baseline. RESULTS: Of the 20 patients recruited (16 female, median age 38.5 years), 80% (16) completed the trial. Five (31%) patients reported at least a point reduction in the Patient Assessment of Constipation Symptoms score, 4 (25%) deteriorated, and 7 (44%) improved by less than one point. Median (interquartile range) Patient Assessment of Constipation Symptoms scores were 2.33 (2.34) at baseline and 2.08 (2.58) at follow-up (p = 0.074). Median scores for the Patient Assessment of Constipation Quality of Life and Cleveland systems were 3.00 (1.64) and 17.15 (18) at baseline and 2.22 (3.04) and 15.31 (12) at follow-up (p = 0.096 and 0.111). One-third of patients reported a positive Global Rating of Change measure, although 68% required concurrent laxatives during the trial. LIMITATIONS: This is a pilot study and is limited by its small sample size. CONCLUSIONS: Continuous transcutaneous sacral stimulation in the short term appears to be ineffective for chronic constipation. Larger well-powered studies with intermittent stimulation regimens are required to investigate this further.
Subject(s)
Constipation , Electric Stimulation Therapy/methods , Lumbosacral Plexus/physiology , Pelvic Floor , Quality of Life , Rectum , Adult , Chronic Disease , Constipation/diagnosis , Constipation/physiopathology , Constipation/psychology , Constipation/therapy , Electric Stimulation Therapy/adverse effects , Female , Gastrointestinal Motility/physiology , Humans , Male , Middle Aged , Pelvic Floor/innervation , Pelvic Floor/physiopathology , Pilot Projects , Radiography , Recovery of Function , Rectum/diagnostic imaging , Rectum/innervation , Rectum/physiopathology , Surveys and Questionnaires , Symptom Assessment/methods , Treatment OutcomeABSTRACT
BACKGROUND: The short-term benefits of laparoscopic surgery are well established, particularly within an enhanced recovery program. Early return to activity is to be expected but has not been quantified. The aim of this study was to measure the hospital stay and return to full activity following laparoscopic colorectal surgery and compare this with laparoscopic cholecystectomy and laparoscopic inguinal hernia repair. METHODS: All totally laparoscopic gallbladder, inguinal hernia, and colorectal operations performed between January 2003 and October 2006 were included. Outcomes were collected from a prospective database and case notes. Post discharge information was collected by telephone interview. A comparison was made by creating 4 groups: laparoscopic cholecystectomy, laparoscopic inguinal hernia repair (Transabdominal PrePeritoneal [TAPP]), laparoscopic colorectal nonresectional, and resectional surgery. RESULTS: The median hospital stay following laparoscopic colorectal resection was 7 days, while in the cholecystectomy and hernia group it was 1 day. The median return to full activity after discharge from the hospital was 4, 5, 3, and 7 days in the laparoscopic cholecystectomy, inguinal hernia repair, nonresection, and colorectal resection groups, respectively. CONCLUSIONS: Following laparoscopic colorectal surgery, patients can be expected to return to their usual activities within a week after discharge from the hospital and less than 2 weeks from surgery.
Subject(s)
Colectomy/statistics & numerical data , Colon/surgery , Laparoscopy/statistics & numerical data , Length of Stay/statistics & numerical data , Recovery of Function , Rectum/surgery , Activities of Daily Living , Aged , Cholecystectomy, Laparoscopic/statistics & numerical data , Female , Hernia, Inguinal/surgery , Humans , Intestinal Diseases/surgery , MaleABSTRACT
BACKGROUND: Gastrocolic fistula is a rare presentation of both benign and malignant diseases of the gastrointestinal tract. Malignant gastrocolic fistula is most commonly associated with adenocarcinoma of the transverse colon in the Western World. Despite radical approaches to treatment, long-term survival is rarely documented. CASE PRESENTATION: We report a case of a 24-year-old woman who presented with the classic triad of symptoms associated with gastrocolic fistula. Radical en-bloc surgery and adjuvant chemotherapy were performed. She is still alive ten years after treatment. CONCLUSIONS: Gastrocolic fistula is an uncommon presentation of adenocarcinoma of the transverse colon. Radical en-bloc surgery with adjuvant chemotherapy may occasionally produce long-term survival.
