Purpose
To define a clinical-MR imaging follow-up protocol for patients after “Stapled Transanal Rectal Resection” (STARR) for surgical correction of rectocele and rectal prolapse conditioning Obstructed Defecation Syndrome (ODS) [1].
This follow-up protocol involves patients 6-12 months after STARR surgery,
and includes a first clinical approach,
in order to investigate symptoms in post-operative period,
and then an objective imaging evaluation by MR-defecography.
In fact,
if there are specific selection criteria for patients undergoing to STARR surgery,
a monitoring post-operative protocol isn’t yet approved.
The presented follow-up,...
Methods and Materials
31 patients,
including 27 women (87.1%) and 4 men (12.9%) with mean age of 56 ± 12 years,
are enrolled for a 6-12 months follow-up protocol after STARR surgery.
Inclusion criteria:
• Patients 18-80 years old;
• Patients who performed MR-defecography in our Institute of Radiology before STARR,
with imaging diagnosis of rectocele and rectal prolapse .
Exclusion criteria:
• Patients with contraindications to MR exam;
• Patients with a history of drug addiction,
psychiatric disorders,
dementia,
or other reasons that may affect compliance during...
Results
Clinical scores results are as follows:
• Cleveland Clinic Constipation Score
using a score of 15 as threshold value for the definition of "constipation":
-12 patients score> 15;
-18 patients score≤ 15.
• Wexner Continence Grading Scale
using a score of 10 as threshold value for the definition of "incontinence":
-10 patients score> 10;
-20 patients score ≤ 10.
As concern MRI findings:
• Intussusception and Rectocele
-in14 patients (47%),
it is visible and measurable,
at MR-defecography,
relapse of rectocele,
with or without rectal intussusception;...
Conclusion
The presented follow-up protocol,
comparing quantified MR-defecografy parameters and clinical assessment of patients by scoring systems,
provides more objective approach to patient after STARR and introduces a standardized short and long term monitoring.
Furthermore,
the classification of patients in 4 categories allows to direct each patient to the most appropriate therapy,
in the event of persistence of symptoms.
Pelvic compartment disorders necessitates a multidisciplinary approach,
because each organic or functional alteration has important implications for static and dynamic pelvic functions [8].
In this sense,
the...
References
Zhang B.
et al.,
Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception. World J Gastroenterol. 2010; 16(20): 2542-8.
Boyadzhyan L.,
Raman S.,
Raz S.,
Role of static and dynamic MR imaging in surgical pelvic floor dysfunction. RadioGraphics 2008; 28: 949-67.
Agachan F.,
Wexner SD et al.,
A constipation scoring system to simplify evaluation and management of constipated patients.
Dis Colon Rectum 1996; 39: 681-5.
Jorge JMN,
Wexner SD,
Etiology and management of fecal incontinence. Dis Colon Rectum 1993; 36:...
Personal Information
-S.
Camisa,
MD - IRCCS Policlinico S.Matteo,
Pavia - Università degli Studi di Pavia
-F.Calliada,
MD - IRCCS Policlinico S.Matteo,
Pavia -
-I.
Fulle,
MD - IRCCS Policlinico S.Matteo,
Pavia -
-G.
Ori Belometti,
MD - IRCCS Policlinico S.Matteo,
Pavia - Università degli Studi di Pavia