ABSTRACT
BACKGROUND: Anismus or non relaxing puborectalis muscle (PRM) may cause obstructed defecation (OD). Reported surgical treatment is partial miotomy, followed by sepsis, bleeding, and incontinence. The aim of the present study was to investigate on the feasibility and outcome of a modified mini-invasive operation. PATIENTS AND METHODS: Consecutive patients with anismus and OD not responding to medical therapy, excluding multiparous females, patients with anal incontinence, recto-rectal intussusception, and disordered psychological pattern. Semi-closed bilateral partial division of PRM, pulled down through 1-cm perianal incisions, was performed. Concomitant significant rectal mucosal prolapse and rectocele, when present, were treated. OD was evaluated using a validated score and anal/vaginal ultrasound (US) was performed pre -and postoperatively. A control group of seven patients with normal bowel habit was also investigated. RESULTS: Eight patients (seven females), median age 48 years (range 29-71) were operated. Six also had significant mucosal prolapse and rectocele. All were followed up for a median of 12 months (range 2-40). None of them had postoperative sepsis or bleeding. One had just one occasional episode of mild anal incontinence. Symptoms improved in 6 or 75 % and, OD score decreased from 19.6 ± 1.0 to 9.2 ± 2.0 (mean ± s.e.m.), P = 0.007. No patient had anismus after surgery and PRM relaxation changed from 0 to 5.9 ± 0.8 mm being 6.6 ± 1.5 mm in controls. CONCLUSION: Semi-closed bilateral partial division of PRM achieves muscle's relaxation on straining in all patients without any significant postoperative complication. Further studies are needed prior to consider it a validated procedure.
Subject(s)
Anus Diseases/surgery , Minimally Invasive Surgical Procedures/methods , Muscle, Skeletal/surgery , Adult , Aged , Anus Diseases/complications , Constipation/etiology , Constipation/surgery , Digestive System Surgical Procedures/adverse effects , Female , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures/adverse effects , Pilot Projects , Prospective Studies , Treatment OutcomeABSTRACT
The psycho-neuroendocrine-immune approach relies on the concept of considering diseases from a holistic point of view: the various components (psyche, nervous system, endocrine system, and immune system) control the diseased organ/apparatus and in turn are influenced by a feedback mechanism. In this article, we will consider the psycho-neuroendocrine-immune approach to coloproctological disorders, by providing clinical cases and discussing them in light of this approach.
Subject(s)
Abdominal Pain/immunology , Constipation/psychology , Fissure in Ano/therapy , Growth Hormone/physiology , Holistic Health , Irritable Bowel Syndrome/immunology , Abdominal Pain/therapy , Adult , Biofeedback, Psychology , Constipation/therapy , Empty Sella Syndrome/complications , Enteric Nervous System/physiopathology , Female , Fissure in Ano/etiology , Humans , Irritable Bowel Syndrome/therapy , Male , Middle Aged , Wound HealingSubject(s)
Adenocarcinoma/surgery , Anal Canal/surgery , Digestive System Surgical Procedures/methods , Muscle, Smooth/surgery , Postoperative Complications/diagnosis , Rectal Neoplasms/surgery , Adenocarcinoma/diagnostic imaging , Adenocarcinoma/pathology , Anal Canal/diagnostic imaging , Anal Canal/pathology , Endosonography , Female , Humans , Middle Aged , Rectal Neoplasms/diagnostic imaging , Rectal Neoplasms/pathology , SyndromeABSTRACT
A novel minimally invasive procedure for the management of anterior external and posterior internal mucosal prolapse is described. The operation, carried out via a transanal route, consists of a partial prolapsectomy and a mucosal proctopexy. Out of six patients, one had severe postoperative bleeding and one had a recurrence of internal prolapse and obstructed defecation. Three patients had pelvic floor rehabilitation for associated dysfunctions. The advantage of the operation is that a circumferential anastomosis is avoided, thus decreasing the risk of dehiscence, and only a short sphincter dilation is required. Moreover, the procedure has very little effect on the rectal reservoir, thus preventing fecal urgency. No reintervention was needed, and almost all patients were cured after 2 years.
