Investigation of Expanded Human Adipose-derived Stem Cell Dosage and Timing for Improved Defecation Function.

BACKGROUND/AIM: Although certain treatment options exist for intestinal incontinence, none are curative. Adipose-derived stem cells (ADSCs) have emerged as promising therapeutic agents, but most preclinical studies of their effectiveness for anal function have used autologous or allogeneic ADSCs. In this study, the effectiveness, timing of administration, and required dosage of human ADSCs were investigated for clinical application. MATERIALS AND METHODS: A 10-mm balloon catheter was used to induce anal sphincter injury in immunodeficient mice in the following experimental groups (n=4 per group): ADSC (injected ADSCs after injury), PBS (injected phosphate-buffered saline after injury), and control (uninjured). The effects of different timing (immediately after injection and 30 days following injury) and number of human ADSCs administered was compared among groups based on defecation status and pathological evaluation. RESULTS: In terms of defecation status, groups receiving ≥1×104 human ADSCs after injection showed improvement. Pathological images showed that compared to the PBS group, the thinnest part of the sphincter was thicker for animals that received ≥1×104 human ADSCs, and fibrosis of the sphincter was notable in those treated with 1×103 human ADSCs or PBS. Furthermore, defecation status was improved by administration of human ADSCs, not only immediately after injury, but also at 30 days following injury. CONCLUSION: Human ADSC administration in a mouse model of anal sphincter injury was effective. Injection of ≥1×104 human ADSCs was the amount necessary to improve defecation status, an effect detected in both the acute and chronic phases.

Analysis of Ethical Review of Clinical Study on Defecation Function of Patients with Rectal Cancer after sphincter-preserving Surgery / 中国医学伦理学

In order to understand the status quo of ethical review of clinical research on the defecation function of patients with rectal cancer after sphincter-preserving surgery, analyze its causes and put forward corresponding suggestions, to arouse researchers’ attention to ethical review in subsequent relevant clinical studies. The ethical review of literatures related to the defecation function of patients with rectal cancer after sphincter-preserving surgery published on CNKI in recent 10 years was sorted out and summarized. The results showed that the ethical review of clinical research papers on defecation function of patients with rectal cancer after sphincter-preserving surgery was not optimistic. We should strengthen the ethical training of researchers, improve the ethical awareness of researchers, strictly implement the ethical norms of paper publication, strengthen the ethical requirements of manuscript contracts, perfect the ethical review system, and pay attention to the examination and supervision of informed consent, so as to promote the construction of ethical examination and approval norms of clinical research documents.

Significance of searching for ganglia in the terminal rectum/fistula of complex anorectal malformations: Related to defecation function.

Background: The need to search for ganglia in the terminal rectum/fistula of complex anorectal malformations (ARMs) remains controversial. This study aims to evaluate the relationship between ganglia absence in the terminal rectum/fistula and defecation function after anoplasty. Methods: A retrospective review of patients who received anoplasty for treating male imperforate anus with rectobulbar (RB)/rectoprostatic (RP) fistulas at a tertiary pediatric hospital was conducted with registered demographic data, imaging study results, and information on the terminal rectum/fistula specimen (excision extension and pathological findings). According to the pathological findings, patients were divided into Groups 1 (ganglia absence) and 2 (ganglia presence). Furthermore, the postoperative defecation function was evaluated using various rating scale questionnaires. Statistical analysis was performed using SPSS 22.0. Results: Of the 62 patients, 18 (29.0%) showed ganglia absence in the terminal rectum/fistula. By analyzing the imaging data, spinal anomalies and spinal cord anomalies were found in 30.6% (19/62) and 56.5% (35/62) of patients, respectively. Baseline information was comparable between Groups 1 and 2 (P > 0.05). For defecation function, there were no significant differences in Kelly scores between the two groups (4.0 ± 0.8 vs. 4.4 ± 1.1, P = 0.177), while Krickenbeck (3.7 ± 1.8 vs. 5.2 ± 1.4) and Rintala (13.7 ± 3.6 vs. 16.0 ± 2.7) scores in Group 1 were significantly lower than those in Group 2 (both P < 0.05). The overall incidence of constipation was 50% (31/62), being higher for Group 1 than Group 2 (77.5% vs. 38.6%, P = 0.002). The area under the curve of ganglia absence for predicting constipation was 0.696, with 77.8% sensitivity and 61.4% specificity. Conclusion: Ganglia absence in the terminal rectum/fistula of male imperforate anus with RB/RP fistulas is associated with constipation after anoplasty, but it has limited predictive value for postoperative constipation. It is necessary to search for ganglia in the terminal rectum/fistula, both intraoperatively and postoperatively.

Clinical features of patients who underwent anoplasty for cloacal exstrophy and their functional outcomes: the results of a nationwide survey in Japan.

PURPOSE: This study was performed to clarify the clinical features of cloacal exstrophy (CE) patients who underwent anoplasty and their functional outcomes based on a nationwide survey in Japan. METHODS: A questionnaire survey was conducted and data were obtained from 229 CE patients. After the exclusion of non-surviving patients and unknown data, 195 patients were enrolled. We compared the patient characteristics of the no anoplasty group (NAP group) to the anoplasty group (AP group). The defecation function of patients who underwent anoplasty was evaluated. RESULTS: The AP group had significantly lower rates of omphalocele (p = 0.045) and spinal defects (p = 0.003) than the NAP group. Of the 195 patients enrolled in this study, only 17 (8.7%) underwent anoplasty. Of the 17 patients who underwent anoplasty, 7 (41.1%) eventually had a permanent stoma after anoplasty [after ileostomy: n = 3 (60.0%), after colostomy: n = 4 (44.4%)]. Regarding soiling, 4 patients (66.7%) showed the absence of soiling, 2 (33.3%) showed accidental soiling, and no patients showed frequent soiling. CONCLUSION: In our study, spinal defects may have affected the determination of anoplasty. Anoplasty may improve the quality of life, because defecation can be kept clean, but indications, including colon function, may be carefully considered.

Impact of defecation dysfunction on quality of life in mid-low rectal cancer patients following sphincter-sparing surgery.

Objectives: A large proportion of mid-low rectal cancer patients develop low anterior resection syndrome (LARS) after Sphincter-sparing surgery. This study aimed to investigate the effect of low anterior resection syndrome (LARS) on quality of life (QoL) in Chinese rectal cancer patients following sphincter-sparing surgery. Methods: This was a comparative cross-sectional study. Between Jan 2019 to Jun 2020, 146 mid-low rectal cancer patients following sphincter-sparing surgery were enrolled. The low anterior resection syndrome (LARS) score was used to assess bowel dysfunction. According to the LARS score, patients were divided into three levels, no LARS (n â€‹= â€‹34), minor LARS (n â€‹= â€‹60), and major LARS (n â€‹= â€‹52). The Functional Assessment of Cancer Therapy-Colorectal (FACT-C) was used to assess the QoL of the patients. Results: The major LARS group had a significantly shorter level of tumor from the dentate line than the no LARS group. The total FACT-C score of 146 patients was 98.45 â€‹± â€‹17.83. The total FACT-C score and the score of each dimension (physical, emotional, functional dimensions, and colorectal cancer subscale) were significantly different between the minor LARS and major LARS groups, as well as between the no LARS and major LARS groups. Subgroups analyses of the FACT-C score stratified by each item in the LARS scales showed that except for flatus incontinence, patients with different frequencies of other symptoms (bowel frequency, liquid stool incontinence, liquid stool incontinence, stool clustering, urgent bowel movement) had a significantly different total score of FACT (all P â€‹< â€‹0.01). Conclusions: The LARS had a significant impact on the QoL in Chinese mid-low rectal cancer patients following sphincter-sparing surgery, especially in patients with major LARS.

[Influence of different sphincter-preserving surgeries on postoperative defecation function].

Advances in surgical techniques and treatment concept have allowed more patients with low rectal cancer to preserve sphincter without sacrificing survival benefit. However, postoperative dysfunctions such as fecal incontinence, frequency, urgency, and clustering often occur in patients with low rectal cancer. The main surgical procedures for low rectal cancer include low anterior rectum resection (LAR), intersphincteric resection (ISR), coloanal anastomosis (Parks) and so on. The incidence of major LARS after LAR is up to 84.6%. The postoperative function of ISR is even worse than LAR. Moreover, the greater the extent of resection ISR surgery, the worse the postoperative function. There are few studies on the function of Parks procedure. Current evidence suggests that the short-term function of Parks procedure is inferior to LAR, but function can gradually recovered over time. Colorectal surgeons have attempted to improve postoperative defecation by modifying bowel reconstructions. Current evidence suggests that J pouch or end-to-side anastomosis during LAR does not reduce the incidence of defecation disorders. Pouch reconstruction during ISR cannot reduce the incidence of severe LARS either. In general, the protection of postoperative defecation function in patients with low rectal cancer still has a long way to go.

[Short-term curative effect and safety on female abdominal obesity and defecation function treated with acupoint embedding therapy at different layers under B ultrasound].

OBJECTIVE: To investigate the short-term effect and safety on female abdominal obesity and defecation function in treatment with acupoint embedding therapy at different abdominal layers under B ultrasound. METHODS: A total of 102 female patients with abdominal obesity were randomly divided into 3 groups, i.e. a deep embedding group (34 cases, 1 case dropped out), a shallow embedding group (34 cases, 3 cases dropped out) and a sham-embedding group (34 cases, 6 cases dropped out). Finally, 92 cases were included in the three groups. Under B ultrasound, in the deep embedding group, the absor-bable surgical suture were embedded in subcutaneous fat layer and muscle layer. In the shallow embedding group, the absorbable surgical suture was embedded in the fat layer and in the sham-embedding group, no suture was embedded. The acupoints for embedding therapy included Zhongwan (CV12), Guanyuan (CV4), bilateral Guanmen (ST22), bilateral Tianshu (ST25), bilateral Daimai (GB26) and bilateral Shuidao (ST28). The acupoint embedding therapy was exerted once every two weeks, for 4 times totally. Before and after treatment, the changes in abdominal obesity indicators (waist circumference ï¼»WCï¼½, body fat rate ï¼»BFRï¼½, body mass index ï¼»BMIï¼½, abdominal subcutaneous fat thickness ï¼»ASFTï¼½) and defecation function indicators (spontaneous bowel movement times ï¼»SBMsï¼½ and Bristol stool scale ï¼»BSSï¼½) were observed and the safety indicators were assessed. RESULTS: After treatment, WC, BFR, BMI and ASFT were lower than those before treatment in both the deep embedding group and the shallow embedding group (P<0.05), those values in the deep embedding group were reduced more obviously as compared with the shallow embedding group (P<0.05). SBMs and BSS after treatment were increased as compared with those before treatment in both the deep embedding group and the shallow embedding group (P<0.05) and the increase in the deep embedding group was more obvious than in the shallow embedding group (P<0.05). The abdominal obesity indicators and defecation function indicators after treatment were not different statistically as compared with those before treatment in the sham-embedding group (P>0.05). The pain score of acupuncture in either the deep embedding group or the shallow embedding group was higher than in the sham-embedding group (P<0.05). The acceptance was more than 2 points in all of the three groups and there was no statistical significance among groups (P>0.05). CONCLUSION: Acupoint embedding therapy in both the deep and the shallow subcutaneous layers under B ultrasound may regulate the indicators of female abdominal obesity safely. The acupoint embedding therapy in the deep layer is more effective on abdominal obesity and defecation improvement as compared with that exerted in the shallow layer.

Pelvic floor peritoneum reconstruction is a protective factor for defecation dysfunction after laparoscopic anterior resection in patients with middle and low rectal cancer.

PURPOSE: The pelvic cavity is a monolithic structure whose integrity plays an important role in the pelvic organ function. Currently, pelvic floor peritoneum reconstruction (PFPR) is rarely performed during laparoscopic surgery for middle and low rectal cancer patients. This study evaluated the effect of PFPR using barbed wire during laparoscopic surgery on the postoperative defecation function in middle and low rectal cancer patients. METHODS: This was a retrospective study involving a total of 252 middle and low rectal cancer patients who had been subjected to laparoscopic-assisted anterior resection of rectal cancer at Shanghai Changhai Hospital from March 2018 to April 2020. The Wexner and low anterior resection syndrome (LARS) scores were used to evaluate the postoperative defecation function among patients. A Wexner score ≥ 8 and LARS score ≥ 30 were considered to indicate major defecation dysfunction. RESULTS: A total of 229 patients (52 patients subjected to PFPR) were followed up, and the Wexner and LARS scores were recorded. The follow-up rate was 90.87%, the mean follow-up time was 22.88 ± 6.93 months, the stoma rate was 64.29%, the ileostomy reduction surgical rate was 90.74%, and the stoma duration was 7.64 ± 2.94 months. Regarding the assessment of postoperative defecation dysfunction using the Wexner score, a multivariate analysis revealed that a long operation time (odds ratio [OR], 0.991; 95% confidence interval [CI], 0.984-0.999, p = 0.026) and radiotherapy (OR, 0.352; 95% CI, 0.156-0.797, p = 0.012) were independent risk factors for major defecation dysfunction, while a high tumor location (OR, 1.318; 95% CI, 1.151-1.657, p = 0.001) and PFPR (OR, 4.770; 95% CI, 1.435-15.857, p = 0.011) were independent protective factors for major defecation dysfunction. Regarding the assessment of the postoperative defecation function using the LARS score, a multivariate analysis revealed that a high tumor location (OR, 1.293; 95% CI, 1.125-1.486, p < 0.001) and PFPR (OR, 3.010; 95% CI, 1.345-6.738, p = 0.007) were independent protective factors for major defecation dysfunction. A subgroup analysis showed that the postoperative Wexner score (3.13 ± 2.79 vs. 4.71 ± 3.45 p = 0.003) and LARS score (21.77 ± 8.62 vs. 25.14 ± 8.78 p = 0.015) were lower for patients with PFPR than for patients without PFPR. Regarding patients with low rectal cancer, those with PFPR had a lower LARS score than those without it (23.62 ± 8.94 vs. 28.40 ± 7.90, p = 0.022), but there was no significant difference in the Wexner score between the groups. A total of 9.76% of patients with PFPR and 48.89% of those without PFPR showed an intestinal accumulation in the sacral front (p < 0.001). CONCLUSIONS: PFPR and a high tumor location are protective factors for postoperative defecation dysfunction in middle and low rectal cancer patients. PFPR can be routinely performed during laparoscopic surgery.

Effect of modified incision drainage combined with thread-drawing and precise minimally invasive surgery in the treatment of anal fistula on anal defecation function and complications / 中国医师进修杂志

Objective:To compare the effects of modified incision drainage combined with thread-drawing and precise minimally invasive surgery in the treatment of anal fistula on anal defecation function and complications.Methods:A total of 105 patients with anal fistula who were diagnosed and treated in Xin′an International Hospital from December 2018 to December 2020 were collected. The patients were divided into the observation group (58 cases) and the control group (47 cases) according to surgical methods. The observation group received modified incision drainage combined with thread-drawing surgery. The control group received precise minimally invasive anal fistula surgery. The treatment outcome, anal defecation function and complications were compared between the two groups.Results:The operation time, intraoperative blood loss, first defecation time after operation, normal eating time after operation in the two groups had no significant differences ( P>0.05). The hospital stay in the observation group was significantly longer than that in the control group: (5.29 ± 1.53) d vs. (4.02 ± 1.16) d, there was statistical differences ( P<0.05). After operation, the resting pressure of the anal canal, resting rectal pressure, length of the tube high pressure belt, the maximum systolic pressure of the anal canal between the two groups had no significant differences ( P>0.05). The excellent and good rate of anal defecation function and complication rate between the two groups had no significant differences ( P>0.05). Conclusions:Modified incision drainage combined with thread-hanging surgery in the treatment of anal fistula is equivalent with precision minimally invasive surgery. Both can effectively improve the anal defecation function. The postoperative safety is good and there is no recurrence. However, the hospital stay of patients with precision minimally invasive surgery for anal fistula is relatively shorter.

Influence of different sphincter-preserving surgeries on postoperative defecation function / 中华胃肠外科杂志

Advances in surgical techniques and treatment concept have allowed more patients with low rectal cancer to preserve sphincter without sacrificing survival benefit. However, postoperative dysfunctions such as fecal incontinence, frequency, urgency, and clustering often occur in patients with low rectal cancer. The main surgical procedures for low rectal cancer include low anterior rectum resection (LAR), intersphincteric resection (ISR), coloanal anastomosis (Parks) and so on. The incidence of major LARS after LAR is up to 84.6%. The postoperative function of ISR is even worse than LAR. Moreover, the greater the extent of resection ISR surgery, the worse the postoperative function. There are few studies on the function of Parks procedure. Current evidence suggests that the short-term function of Parks procedure is inferior to LAR, but function can gradually recovered over time. Colorectal surgeons have attempted to improve postoperative defecation by modifying bowel reconstructions. Current evidence suggests that J pouch or end-to-side anastomosis during LAR does not reduce the incidence of defecation disorders. Pouch reconstruction during ISR cannot reduce the incidence of severe LARS either. In general, the protection of postoperative defecation function in patients with low rectal cancer still has a long way to go.

Defecation Function After Laparo-Assisted Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis for Ulcerative Colitis.

Background: Defecation status is an important determinant of quality of life. Previous studies showed that postoperative defecation disorders occurred after open surgery for ulcerative colitis (UC), but few have investigated defecation status after laparo-assisted surgery. The added precision and magnification provided with laparo-assisted surgery should lead to less damage to the anal sphincter muscle. This study investigated defecation function after a laparo-assisted restorative proctocolectomy (RPC) with ileal pouch anal anastomosis (IPAA). We also clarified factors that worsened defecation status. Methods: This retrospective study included 57 patients who underwent laparo-assisted RPC with IPAA for UC from January 2000 to May 2019. At 1 year after surgery, functional outcomes were evaluated with the Kirwan classification and Wexner score. Risk factors for poor defecation status were investigated with multiple regression. Results: At 1 year after surgery, the median Kirwan classification score was 2 and the median Wexner score was 8. Defecation disorder was observed in 19 (33.3%) patients, according to the Kirwan classification, and 15 (26.3%) patients, according to the Wexner score. Hand-sewn IPAA was associated with defecation disorder (P = .04), evaluated with the Kirwan classification. Hand-sewn IPAA (P = .01), older age (P = .03), high body mass index (P = .04), and the surgical indication (cancer/dysplasia; P = .03) were significantly associated with defecation disorder, evaluated with the Wexner score. The multivariable analysis showed that hand-sewn IPAA was an independent risk factor (P = .049; odds ratio: 4.99; 95% confidence interval: 1.0-28.39). Conclusions: We found that hand-sewn IPAA was a risk factor for defecation disorders after laparo-assisted RPC for UC.

Defecation function and quality of life in patients with slow-transit constipation after colectomy.

BACKGROUND: Although total or subtotal colectomy for slow-transit constipation (STC) has been proven to be a definite treatment, the associated defecation function and quality of life (QOL) are rarely studied. AIM: To evaluate the effectiveness of surgery for STC regarding defecation function and QOL. METHODS: From March 2013 to September 2017, 30 patients undergoing surgery for STC in our department were analyzed. Preoperative, intra-operative, and postoperative 3-mo, 6-mo, 1-year, and 2-year follow-up details were recorded. Defecation function was assessed by bowel movements, abdominal pain, bloating, straining, laxative, enema use, diarrhea, and the Wexner constipation and incontinence scales. QOL was evaluated using the gastrointestinal QOL index and the 36-item short form survey. RESULTS: The majority of patients (93.1%, 27/29) stated that they benefited from the operation at the 2-year follow-up. At each time point of the follow-up, the number of bowel movements per week significantly increased compared with that of the preoperative conditions (P < 0.05). Similarly, compared with the preoperative values, a marked decline was observed in bloating, straining, laxative, and enema use at each time point of the follow-up (P < 0.05). Postoperative diarrhea could be controlled effectively and notably improved at the 2-year follow-up. The Wexner incontinence scores at 6-mo, 1-year, and 2-year were notably lower than those at the 3-mo follow-up (P < 0.05). Compared with those of the preoperative findings, the Wexner constipation scores significantly decreased following surgery (P < 0.05). Thus, it was reasonable to find that the gastrointestinal QOL index scores clearly increase (P < 0.05) and that the 36-item short form survey results displayed considerable improvements in six spheres (role physical, role emotional, physical pain, vitality, mental health, and general health) following surgery. CONCLUSION: Total or subtotal colectomy for STC is not only effective in alleviating constipation-related symptoms but also in enhancing patients' QOL.

When do defecation function and quality of life recover for patients with non-ostomy and ostomy surgery of rectal cancer?

BACKGROUND: Rectal cancer (RC) surgery often results in permanent colostomy, seriously limiting the quality of life (QOL) in patients in terms of bowel function. This study aimed to examine defecation function and QOL in RC patients who underwent non-ostomy or ostomy surgery, at different time-points after surgery. METHODS: In total, 82 patients who underwent an ostomy and 141 who did not undergo an ostomy for the treatment of RC at our colorectal surgery department between January 2013 and January 2015 were enrolled. Surgical methods, tumor distance from the anal margin (TD), anastomosis distance from the anal margin (AD) and complications were compered between the non-ostomy and ostomy surgery groups. QOL was compared between the two groups at years 2, 3, and 4 after surgery. The Wexner score and the validated cancer-specific European Organization for Research and Treatment of Cancer (EORTC QLQ-CR30) questionnaire scores were assessed for all patients in January 2017. SPSS 21.0 was utilized for all data analyses. RESULTS: Surgical methods, TD, and AD significantly differed between the non-ostomy and ostomy surgery groups (all P < .001). However, no differences were found in the number of complications between the groups (P = .483). For the 192 patients undergoing Dixon surgery, role function (RF), global QOL (GQOL), sleep disturbance, and the incidence of constipation showed significant differences between the two groups (P = .012, P = .025, P = .036, and P = .015, respectively). In the 31 cases of permanent ostomy, we observed significant differences in GQOL scores, dyspnea incidence, and financial difficulties across the different years (P = .002, P = .036, and P < .01, respectively). Across all 223 cases, there were significant differences in social function and GQOL scores in the second year after surgery (P = .014 and P < .001, respectively). However, no differences were observed in the other indices across the three time-points. CONCLUSIONS: RC patients undergoing ostomy surgery, especially those with low and super-low RC, revealed poorer defecation function and QOL in the present study. However, 2 years after surgery, most of the defecation and QOL indicators showed recovery.

Structural changes of rectal smooth muscle after spinal cord injury in rats / 上海交通大学学报（医学版）

Objective: To investigate the changes of rectal smooth muscle structure after spinal cord injury in rats. Methods: Twenty adult female Sprague-Dawley rats were randomly divided into two groups,i.e.,spinal cord injury group and control group. In the spinal cord injury group,the spinal cord was completely disconnected between L5 and L6,and control group was not surgically treated. After 3 months,gastric instillation was used to measure the intestinal transit time with the administration of activated carbon suspension and the mass of fecal pellets within 24 h was recorded. Then the rectal tissue was taken at about 1 cm proximal to the anus. The changes of rat rectal smooth muscle were detected by hematoxylin-eosin (H-E) staining,Masson staining and immunohistochemistry staining. Results: Gastric instillation showed that compared with control group,the intestinal transit time of spinal cord injury group significantly prolonged,and the mass of fecal pellets within 24 h significantly reduced. H-E staining showed that the arrangement of rat rectal smooth muscle cells was disordered after spinal cord injury. Masson staining showed fibrotic changes in the rectal smooth muscle layer of rats after spinal cord injury. Immunohistochemistry staining showed that the expression of α smooth muscle actin (α-SMA) in rat rectal smooth muscle decreased after spinal cord injury. Conclusion: After spinal cord injury,rats present defecation dysfunction. The structure of rectal smooth muscle also changes significantly,mainly including smooth muscle atrophy,fibrosis and decreased α-SMA expression.

Investigation of the feasibility and safety of single-stage anorectoplasty in neonates with anovestibular fistula.

PURPOSE: Anovestibular fistula (AVF) is the most common type of anorectal malformation in females. Delayed anorectoplasty with fistula dilatation is commonly performed during infancy; however, we have been actively performing anorectoplasty in neonates. We report the surgical complications and postoperative defecation function associated with single-stage anorectoplasty performed in neonates. METHODS: Patients who underwent surgery for AVF between 2007 and 2017 at two institutions were retrospectively studied. The operation time, amount of bleeding, time to start oral intake, perioperative complications, and Kelly's score were compared among patients who underwent surgery as neonates and those who underwent surgery as infants. RESULTS: Eighteen neonates and 17 infants underwent anterior sagittal anorectoplasty. The median operation time and time to start oral intake were significantly shorter in the neonatal group (72 min; 3 days, respectively) than in the infant group (110 min, p = 0.0002; 5 days, p = 0.0024, respectively). Postoperative wound disruption was significantly more frequent in the infant group. Of the ten patients each in the neonatal and infant groups, there was no significant difference in Kelly's score at age ≥ 4 years. CONCLUSION: Single-stage anorectoplasty in neonates with AVF can be feasibly performed and does not impair postoperative defecation function. LEVELS OF EVIDENCE: III.

Change in anorectal function after low anterior resection of rectal cancer / 国际肿瘤学杂志

After lower rectal anterior resection, patients often experience defecation disorders such as increased stool frequency and fecal incontinence. Researches have shown that these disorders may be resulted from pathophysiological consequences such as impaired neorectal compliance, decreased internal anal sphincter function, direct damage or injury of the nervous supply and the loss of rectal sensation.

Effects of Acupuncture on the Constipation in Rats Model / 针灸推拿医学（英文版）

Objective: To investigate the effects of acupuncture on constipation in rats. Method:Compound diphenoxylate was used to set up rat model of constipation. After needling Heguand Housanli, the time to first bowel movement, and stool grains quantity and weight in 12 rats were observed. Results: The time to first bowel movement was delayed, and the stool grains quantity and weight were reduced in the model rats. Acupuncture could significantly shorten the time to first bowel movement, and increase stool grains quantity and weight.Conclusion: Acupuncture can improve the defecating abilities in rats model of constipation.