Transanal surgery for obstructed defecation syndrome: Literature review and a single-center experience.

Obstructed defecation syndrome (ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychological aspects. The underlying anatomical and pathophysiological changes of ODS are complex. However, intra-rectal intussusception and rectocele are frequently found in patients with ODS and both are thought to play an important role in the pathogenesis of ODS. With the development of evaluation methods in anorectal physiology laboratories and radiology studies, a great variety of new operative procedures, especially transanal procedures, have been invented to treat ODS. However, no procedure has been proved to be superior to others at present. Each operation has its own merits and defects. Thus, choosing appropriate transanal surgical procedures for the treatment of ODS remains a challenge for all surgeons. This review provides an introduction of the current problems and options for treatment of ODS and a detailed summary of the essential assessments needed for patient evaluation before carrying out transanal surgery. Besides, an overview of the benefits and problems of current transanal surgical procedures for treatment of ODS is summarized in this review. A report of clinical experience of some transanal surgical techniques used in the authors' center is also presented.

A transanal procedure using TST STARR Plus for the treatment of Obstructed Defecation Syndrome: 'A mid-term study'.

PURPOSE: The aim of this study was to assess the safety, efficacy and outcomes of TST STARR (Stapled Transanal Rectal Resection) plus to treat Obstructed Defecation Syndrome (ODS) at mid-term follow-up. METHODS: From April 2013 to September 2014, 50 cases (7 male patients) with ODS caused by rectocele and/or internal rectal prolapse were treated with the new TST STARR Plus. Clinical data from the 18 month mid-term follow up, including efficacy and constipations were recorded. RESULTS: The average duration of surgery was 21 ± 4 min (range 12-35 min). The average postoperative hospital stay was 5 days (range 4-8 days). The pathological findings showed that the specimens contained full-thickness rectal tissue in all patients. The mean volume of resected specimen was 12.3 cm(3). Postoperative complications included five cases with transient faecal urgency that dissipated after 3 months; one patient suffered anastomotic bleeding on the sixth day after surgery, with successful haemostasis achieved through conservative therapy. The Wexner constipation score improved in patients affected by ODS from 13.96 ± 2.37 preoperatively to 7.00 ± 3.90, 7.28 ± 3.91, 8.10 ± 4.05 and 8.44 ± 4.08 at 3,6,12 and 18 months postoperatively, respectively, with all p < 0.05. Overall outcome was reported as ''excellent'' in 42% of patients, ''good'' in 36% of patients, ''adequate'' in 12% of patients, and ''poor'' in 10% of patients after 18 months of follow-up. CONCLUSIONS: The TST STARR Plus is a simple, safe, and effective option for selected patients with ODS. Long-term prospective clinical studies are needed to validate the advantages of this emerging, novel procedure.

Comparative evaluation of microleakage of two self-etching dentin bonding agents on primary and permanent teeth. An in vitro study.

AIM: Conservative procedures using dentin bonding agents are one of the important aspects of paediatric dental practice. The objective of this in vitro study was to comparatively evaluate the microleakage of two self etching adhesives in primary and permanent teeth. MATERIALS AND METHODS: Sixty-four human anterior teeth (thirty-two primary and thirty-two permanent) were divided into four groups: primary teeth bonded using a 6th generation (Contax) bonding agent; permanent teeth bonded using a 6(th) generation (Contax) bonding agent; primary teeth bonded using a 7(th) generation (Clearfil S3) bonding agent; permanent teeth bonded using a 7(th) generation (Clearfil S3) bonding agent. A Class V cavity was prepared on all samples and were restored with composite resin as per manufacturers' instruction. After thermocycling, the teeth were stained with methylene blue, sectioned, and measured for microleakage. RESULTS: It was found a statistically significant difference in microleakage between incisal and gingival margins in each of the study group. CONCLUSION: Clearfil S3 (7(th) generation) bonding agent could be of greater advantage in paediatric dentistry than Contax (6(th) generation) because of its fewer steps and lesser microleakage in both primary and permanent teeth.