Constipation Score Research Articles

The effect of foot reflexology on constipation and quality of life in patients with multiple sclerosis. A randomized controlled trial

BackgroundConstipation is a major problem in most patients with multiple sclerosis (MS). The aim of this study was to investigate the effect of foot reflexology on constipation and quality of life in patients with MS. MethodsThis study was a randomized controlled trial, in which 63 patients with MS referred to Arak MS Society, Iran were participated (from May to Dec. 2018). In this study participants were selected according to inclusion criteria and randomly divided into intervention (n = 33) and control (n = 30) groups. In the intervention group, foot reflexology was applied twice a week for 6 weeks (each session lasted about 30−40 min). Data were collected using demographic questionnaire, Constipation Assessment Scale (CAS) and Short Form (SF) 36 Quality of Life (QOL) questionnaire. Finally, the data were analyzed using SPSS Ver. 16 and descriptive and inferential statistical tests. ResultsThe results of the study showed that severity of constipation and QOL score were not significant between the two groups before intervention (p > 0.05), but; after intervention, severity of constipation significantly decreased in the reflexology group (p < 0.05). Nevertheless, after intervention, the QOL was improved in the reflexology group compared to the control group but was not significant (p > 0.05). ConclusionThe results of this study showed that foot reflexology, as an effective intervention can be useful in management of constipation in patients with MS. Therefore, this intervention can be applied as a safe method for the decrease of constipation in MS patients.

Nutritional status and constipation scoring of inguinal hernia patients: a case-control study.

There are many risk factors for inguinal hernia that have been determined in the literature, but the relationship between nutritional status and inguinal hernia has not yet been examined. In this study, we evaluated the constipation scale and food consumption of patients with inguinal hernia. This prospective case-control study was performed between March 2018 and March 2019. The patients who were admitted for inguinal hernia operation were the case group, and those patients who had been admitted to the same hospital without inguinal hernia were the control group. The age, body mass index, alcohol and smoking habits, daily activity, and the Wexner constipation scoring were examined using a questionnaire and 3-day food consumption records were noted. A total of 203 volunteers were included in the study. Of these, 88 patients were in the control group, and 115 patients were in the case group. The age and gender distribution of the groups was similar. Cigarette and alcohol usages are statistically high in the case group. The Wexner constipation scale of the groups was statistically high in the case group. In the univariate analysis, smoking, alcohol consumption, total constipation score, red meat consumption, chicken consumption, bread consumption, low fiber consumption, low egg consumption, low carbohydrate, and low energy intake were effective in hernia formation, and in the multivariate analysis, total constipation score, red meat consumption, chicken consumption, excess bread consumption, low energy intake, and low fiber consumption were significant as independent variables. Our study is the first to evaluate whether there is a relationship between inguinal hernia and nutrition, according to the literature. Lifestyle modifications and a healthy diet with the consumption of less meat and more vegetables may have an impact on the reduction of hernia occurrence.

Functional outcome, quality of life, and ‘failures’ following pull-through surgery for hirschsprung's disease: A review of practice at a single-center

AimsThe purpose of this study was to assess bowel function and quality of life (QoL) in patients with Hirschsprung's disease (HD) and identify patients who have ‘failed’ treatment. MethodsA review of a single-center HD cohort treated with pull-through surgery from 2004 to 2017 was completed. Bowel function of patients five years and above and QoL of all patients were assessed using validated questionnaires. Patients who ‘failed’ treatment were defined as above five years with one or more of: a) long-term stoma, b) needing an antegrade continence enema or transanal irrigation, c) severe soiling, or d) severe constipation. Statistical analysis was performed with P < 0.05 deemed significant. Data are given as mean [range]. ResultsSeventy-one patients presented with HD within the study period. Mean follow-up was 5.4 years [0.7–13.3]. Of 38 eligible patients, bowel function was assessed in 24 patients (nine had a stoma, five lost to follow-up). The mean incontinence score was 17 [0–28)], and the mean constipation score was 17 [5–25]. Incontinence and constipation scores were worse than healthy controls (P < 0.001 and P = 0.001, respectively) and did not improve with age. Fifty-six patients had QoL assessed with no difference between our cohort (81 [25–100]) and healthy controls (81 [unknown]); (P = 0.85). Thirty-three patients were assessed for ‘failure’ (bowel function score n = 24; stoma n = 9). Thirty of 33 (91%) children older than five years can be considered to have ‘failed’ treatment. ConclusionsPatients have worse bowel function than healthy children, which does not improve with age. QoL is comparable to healthy controls. A significant proportion of patients have poor outcomes and have ‘failed’ treatment. Level of evidenceLevel III.

Botulinum toxin injection for internal anal sphincter achalasia after pull-through surgery in Hirschsprung disease.

Botulinum toxin (Botox) was introduced for the management of internal anal sphincter (IAS) achalasia after a pull-through procedure in Hirschsprung disease (HD). We conducted a prospective evaluation of the efficacy and safety of this Botox treatment.Our study group included 15 patients with HD (median age, 4.8 years; range, 1.7–7.4 years) who experienced persistent constipation after pull-through surgery. Rectal biopsy and colon study were performed before Botox injection to exclude agangliosis. Intersphincteric Botox injections (dose, 4 IU/kg) were performed at 3 sites, (3, 6, and 9 o’clock) under general anesthesia. Measured outcomes of efficacy included anorectal manometry, Wexner constipation score and the quality of life score for defecation, measured at baseline and at 2 weeks and 3 months after injection. The Holschneider incontinence score and an assessment of pain, bleeding, heating sensation, and swelling were also performed at follow-up as outcomes of safety.There was no significant change in measured outcomes with Botox treatment. Botox did decrease the number of patients who experienced abdominal distension at 3 months, compared to 2-weeks, post-injection. No major complications were identified, with only 2 cases of anal bleeding that resolved spontaneously. Local tenderness at the injection site was reported by 4 patients, recovering without treatment.The efficacy of Botox, injected into the IAS, for the treatment of achalasia is questionable on short-term follow-up. Larger studies with a longer follow-up period and the use of repeated injections are required to evaluate the evidence for this treatment.

Clinical efficacy of Japanese herbal medicine daikenchuto in the management of fecal incontinence: A single-center, observational study.

Objectives: The purpose of this study was to investigate whether the symptoms of fecal incontinence (FI) or anal sphincter dysfunction are improved by daikenchuto (DKT). Methods: This is a retrospective observational study that analyzes the effects of DKT. The study was conducted at Kunimoto Hospital. Patients who visited the hospital from January 2012 to December 2016 due to symptoms of FI with a certain degree of chronic constipation and who took DKT were enrolled. The drug to be evaluated was “Tsumura Daikenchuto Extract Granules for Ethical Use (TJ-100)” manufactured by Tsumura & Co., Tokyo, Japan. The primary outcome measures were changes in the scores of the Cleveland Clinic Incontinence Score (CCIS) and Constipation Scoring System (CSS) before and after the administration of DKT. Results: A total of 157 patients were enrolled. On the CCIS, “leakage of solid stool,” “leakage of liquid stool,” “pad use,” and “total score” were significantly improved. On the contrary, on the CSS, the score of “type of assistance” was significantly improved after the administration of DKT, but no significant difference was found in the total score. On the Bristol Stool Form Scale, the administration of DKT showed a tendency to normalize stool consistency. Maximum resting anal pressure and maximum squeeze anal pressure significantly increased after the administration of DKT. No side effects caused by DKT were observed during the study. Conclusions: DKT appears to be a safe and useful agent for the management of FI in patients with defecation disorders and internal anal sphincter dysfunction.

Clinical Characteristics of Different Primary Constipation Subtypes in a Chinese Population.

Goal:To investigate the clinical characteristics of different primary constipation subtypes, including symptom clusters, psychological problems, quality of life (QOL), and to explore the role of constipation symptoms and the mental state in the QOL of constipation subtypes.Background:Patients with chronic constipation (CC) may be unsatisfied with their therapy and suffer recurrent symptoms. Different constipation subtypes require different treatments; therefore, it is important to identify the features of different constipation subtypes.Study:CC patients (n=206) visiting our gastroenterology clinic were studied. CC subtypes were diagnosed using the Rome-IV criteria. We used validated questionnaires to investigate the symptom severity, mental state, and QOL of patients. QOL was assessed with the Patient Assessment of Constipation Quality of Life (PAC-QOL) and SF-36 questionnaire. Results of symptom, mental and QOL scores are expressed as means with 95% confidence interval.Results:Three groups of CC patients differed in their constipation scoring system and the Patient Assessment of Constipation Symptoms (PAC-SYM) total scores, and both were significantly higher in the functional defecation disorder (FDD) group compared with that in the normal transit constipation (NTC) group. FDD patients tended to have more severe “abdominal symptoms,” “rectal symptoms” than NTC group. No significant difference in General Anxiety Disorder 7-item or Patient Health Questionnaire-9 results was found among the 3 groups. Significantly more patients with FDD suffered more “physical discomfort” and had poorer QOL in the “physical function” dimension of SF-36. FDD and NTC patients mainly showed associations between CC-related QOL and constipation severity, while slow transit constipation patients’ QOL was significantly associated with anxiety and depression.Conclusion:Patients with FDD suffer more severe constipation symptoms and have a lower QOL than patients in other CC subgroups. FDD and NTC patients’ QOL is mainly linked to constipation symptoms, while that of slow transit constipation is mainly related to mental states such as anxiety and depression.

1217 Gastroparesis Dietary Recommendations in Patients With Gastroparesis-Like Symptoms Are Only Effective in Normal Colon Transit Documented by Wireless Motility Capsule Methodology

INTRODUCTION: We previously reported a positive impact of gastroparesis diet recommendations on overall and individual symptoms in patients with suspected gastroparesis who show gastric emptying delays. In contrast, those with non-delayed gastric emptying showed only minimal benefits on this diet. The impact of gastroparesis diet recommendations in patients with delayed colon transit (DCT) based on Wireless Motility Capsule (WMC) testing has not been assessed. We hypothesized that patients with normal colon transit (NCT) presenting with upper GI symptoms respond to a gastroparesis diet while those with DCT do not respond. METHODS: Patients with suspected gastroparesis at 10 tertiary centers underwent concurrent WMC testing and gastric emptying scintigraphy. Several treatment recommendations, including a gastroparesis diet (low fat, low fiber and low residue diet with small-sized but frequent meals) were recommended for 31 patients with NCT and 15 with DCT. For this analysis, overall GCSI, and individual symptom scores from PAGI-SYM surveys (0 = none, 5 = very severe) at baseline and 6- month follow-up on the gastroparesis diet were related to the presence or absence of DCT defined as colon transit exceeding 59 hours by WMC. RESULTS: Gastroparesis diet recommendations were associated with overall GCSI and PAGI-SYM score reductions from 2.6 ± 1.1 to 2.1 ± 1.1 (P = 0.004) and 2.5 ± 1.1 to 1.9 ± 1.2 (P = 0.0004), respectively, in patients with NCT. Individual symptoms of bloating, fullness and diarrhea also improved with NCT (P &lt; 0.02 for all) (Table 1). Constipation and lower abdominal pain scores did not differ pre- and post- gastroparesis diet recommendations. In patients with DCT, only constipation improved over 6 months (P = 0.04). This finding may be explained by increased use of laxatives in this group after DCT was found on WMC testing. CONCLUSION: This is the first study to show a differential impact of gastroparesis diet recommendations in patients with suspected gastroparesis based on colon transit findings by wireless motility capsules. A positive impact of the gastroparesis diet with long-term benefits on overall and individual symptoms up to 6 months in patients with suspected gastroparesis and normal colonic transit was seen. In contrast, patients with delayed colon transit had lesser benefits from gastroparesis diets. Whole gut transit testing with WMC may differentiate responders and non-responders to the gastroparesis diet based on colonic transit times.

Clinical observation of perineal rectosigmoidectomy for rectal prolapse

Objective To evaluate the clinical observation of rectal prolapse by partial perineal rectal sigmoidectomy. Methods Sixty patients with rectal prolapse who met the diagnostic criteria of rectal prolapse in Yiwu Central Hospital from April 2013 to June 2015 were selected as the research subjects.They were divided into two groups according to random number table, with 30 cases in each group.The observation group used Altemeier, and the control group underwent triple surgery (rectal mucosal ligation, periorbital injection, and anal ring retraction). The total effective rate after surgery was compared and analyzed. Results The operation of the two groups was successfully completed.The total effective rate of the observation group was 96.67%, which was significantly higher than 80.00% of the control group, the difference was statistically significant(χ2=5.856, P=0.048). The Wexner constipation score of the observation group was (1.4±1.6)points, which was significantly lower than that of the control group[(3.2±2.0)points, t=3.849, P<0.05]. The Wexner anal incontinence score of the observation group after 24 months was (2.9±1.8)points, which was significantly lower than that of the control group [(4.4±2.7)points, t=2.532, P<0.05]. The proportions of anastomotic bleeding, pelvic swelling and perianal eczema in the observation group were 0.00%, 0.00% and 3.33%, respectively, which were significantly lower than those in the control group(20.00%, 23.33% and 30.00%, χ2=4.630, 5.822, 7.680, all P<0.05). Conclusion Altemeier can significantly improve the quality of life of patients, with a high cure rate and good clinical results. Key words: Rectal prolapse; Colectomy; Treatment outcome; Constipation; Anal incontinence; Rectal mucosal alignment ligation; Perirectal injection; Anal annular contraction

Ventral rectopexy with biological mesh for recurrent disorders of the posterior pelvic organ compartment

Recurrent prolapse of the posterior pelvic organ compartment presents a management challenge, with the best surgical procedure remaining unclear. We present functional outcome and patient satisfaction after laparoscopic and robotic ventral mesh rectopexy (VMR) with biological mesh in patients with recurrence. We analyzed data from 30 patients with recurrent posterior pelvic organ prolapse who underwent VMR with biological mesh from August 2012 to January 2018. Data included patient demographics and intra- and postoperative findings; functional outcome as assessed by Cleveland Clinic Constipation Score (CCCS), Obstructed Defecation Score Longo (ODS), and Cleveland Clinic Incontinence Score (CCIS); and patient satisfaction. CCCS, CCIS, and ODS were significantly improved at 6-12months postoperatively and at last follow-up. Patient satisfaction (visual analog scale [VAS] 6.7 [0 to 10]), subjective symptoms (+ 3.4 [scale - 5 to + 5]), and quality of life improvement (+ 3.0 [scale from - 5 to + 5]) were high at last follow-up. The rates of morbidity and major complications were 13% and 3%, respectively. There were no mesh-related complications or deaths. Difference in type of previous surgery (abdominal or transanal/perineal) had no significant effect on results. VMR with biological mesh is a safe and effective option for patients with recurrent posterior pelvic organ prolapse. It reduces functional symptoms, has a low complication rate, and promotes patient satisfaction.

Functional Outcome after Laparoscopic Posterior Sutured Rectopexy Versus Ventral Mesh Rectopexy for Rectal Prolapse: Six-year Follow-up of a Double-blind, Randomized Single-center Study

SummaryBackgroundLaparoscopic ventral mesh rectopexy (LVMR) for rectal prolapse has been implemented to reduce postoperative bowel symptoms. The preoperative-to-postoperative change in a double-blinded, randomized study comparing it to laparoscopic posterior sutured rectopexy (LPSR) found no significant difference between the two procedures after one year. The aim of this study was to investigate the long-term functional outcomes.MethodsFrom November 2006–January 2014, 75 patients were randomized to LVMR (n = 37) or LPSR (n = 38). In March 2017, questionnaires containing constipation symptom score (PAC-SYM), quality of life score (PAC-QoL), obstructed defecation score (ODS), Cleveland clinic constipation and incontinence scores (CCCS, CCIS) were mailed to all the patients included in the RCT. Prolapse recurrences and mesh complications were recorded.FindingSixty-nine patients were available for long-term follow-up. Questionnaires were completed by 64 patients (94.4%). The median follow-up was 6.1 years. The total PAC-QoL was significantly lower in the LVMR group 0.26 (0.14–0.83) compared to the LPSR group 0.93(0.32–1.61)(P = 0.008). The total PAC-SYM was significantly lower in the LVMR group 0.5 (0.21–0.87) compared to the LPSR group 1.0 (0.5–1.5)(P = 0.031). Except for CCIS, the ODS and the CCCS significantly favored the LVMR group at six years (P = 0.011 & 0.017). Only three(8.82%) patients in the LVMR group developed recurrence compared to seven(23.33%) in the LPSR group (P = 0.111).InterpretationThe long-term functional outcome after LVMR is superior to that after LPSR. Larger multicenter studies are warranted.FundingNone.

Gut Environment and Dietary Habits in Healthy Japanese Adults and their Association with Bowel Movement

Introduction: Constipation is a common symptom that impairs the quality of life (QOL). This study aimed to investigate the relationship between bowel movement and gut microbiota and dietary intake. Methods: To investigate correlations among bowel movement, food intake, and gut environment, 60 healthy Japanese participants were recruited. Bowel movement was assessed using the Bristol stool form scale (BSFS) and constipation scoring system (CSS). Dietary habit was assessed with a self-administered questionnaire wherein the food intake frequency was classified into 8 categories for 72 food/food groups. Gut microbiota was analyzed using terminal restriction fragment length polymorphism analysis. Results: The constipation rate was significantly higher in females than in males. The QOL was significantly impaired in the constipated group. The fecal count of Bacteroides was decreased and that of Clostridium cluster IV was increased in participants with constipation. The BSFS score was negatively associated with the fecal count of Clostridium cluster XI and positively associated with the fecal count of Clostridium cluster XVIII and consumption of green tea. The total CSS score was positively associated with the fecal Prevotella count and negatively associated with fecal acetate levels and consumption of vegetables. Discriminant analysis estimated that constipation could be predicted correctly in 83% (p < 0.001) of the participants based on fecal microbiota and fecal short-chain fatty acids. Discussion/Conclusion: Bowel movement was strongly affected by gut environment and food intake in Japanese participants. Improvement in dietary habits could promote bowel movement through the improvement of the environment in the gut, resulting in ameliorated QOL issues in healthy adults.

Association between a constipation scoring system adapted for use in children and the dysfunctional voiding symptom score in children and adolescents with lower urinary tract symptoms

A presumed association between more severe lower urinary tract symptoms (LUTS) and more severe functional constipation (FC) remains unconfirmed. Because the Rome IV criteria do not quantify FC, an adult constipation scoring system was modified and adapted for use in children. The objective of this study was to assess the correlation between FC severity as determined by the modified constipation scoring system and LUTS severity in children/adolescentsand the correlation between this modified scoring system and the Rome IV criteria. This was a cross-sectional study including 5- to 17-year-old patients with LUTS, with or without FC. Patients with neurological and/or anatomical abnormalities of the genitourinary and/or gastrointestinal tract were excluded. Girls with Dysfunctional Voiding Symptom Score (DVSS) ≥6 and boys with DVSS ≥9 were diagnosed with lower urinary tract dysfunction (LUTD). Patients with at least two positive Rome IV criteria were considered constipated. The severity of FC according to the adapted constipation scoring system was classified as mild for scores of 1-10, moderate for scores 11-20, and severe for scores 21-30. Of 128 patients with LUTS, 71 (55.5%) were female. Lower urinary tract dysfunction was detected in 107 patients (83.6%) and was more common in girls. Functional constipation was present in 80 patients (62.5%). Constipated children had higher constipation scores and DVSS, with both scores increasing with the severity of FC. Correlation was moderate between the constipation score and the DVSS (þ=0.5, p<0.001) and was strong between positivity for a greater number of Rome IV criteria and the constipation score (þ=0.7, p<0.001). Most of the constipated patients had mild or moderate FC, while in 30 non-constipated patients, the constipation score indicated mild FC. Patients from a specialist center are more likely to have more severe medical problems, and this may have influenced the correlation between the scores. The modifications made to the constipation scoring system require a future validation study. Nevertheless, this study provides new data on urinary dysfunction and its association with FCand highlights the need to investigate occult bowel symptoms that could affect the treatment of urinary dysfunction. The intensity of FC as measured by the modified constipation scoring system correlated with the severity of the urinary symptoms in children/adolescents with LUTS/LUTD. In constipated patients, there was a correlation between the modified constipation scoring system and the Rome IV criteria. In non-constipated patients, the constipation scoring system identified symptoms/signs of bowel dysfunction not picked up by the Rome IV criteria. Finally, constipation score modified for use in children and adolescents could be important for research purpose and particularly having a prognostic importance.

Comparison of clinical effectiveness of nurse led care among Chinese patients with cancer: A prospective study evaluating effective patient care compared to consultant oncologist

ObjectiveThe NLC model in oncology setting was not well established in China, and there was no study evaluating the clinical effectiveness of NLC versus oncologist-led care (OLC) in Chinese patients with cancer. We therefore designed a pilot study to evaluate the clinical usefulness after NLC versus OLC in Chinese patients with cancer. MethodsThis pilot, single center, prospective study was designed to evaluate clinical effectiveness of NLC versus oncologist-led care (OLC) in Chinese patients with cancer. Adult patients of either gender (aged between 20 and 65 years) who were diagnosed with any cancer at China were included. The patients’ with stage IV cancer or who were not willing to give written consent to participate in this study were excluded during screening phase of our study. We assessed the symptoms from each enrolled patients, the most common symptoms associated with any cancer patients are pain, dyspnea and constipation. Also distress symptoms (caused by pain and dyspnea) and low quality of life are seen in patients with advanced stage of cancer. ResultsA total of 220 patients who were visited in our hospital for consultation were enrolled and assigned to nurse led care and oncologist led care group (110 patients in each group). Pain intensity, dyspnea intensity and constipation intensity was recorded for patients of nurse led care and oncologist led care group. Pain intensity, dyspnea intensity and constipation intensity on numerical rating scale was numerically lesser in Nurse led care group as compared to oncologist led care group. However, the difference was not statistically significant (p>0.05). The mean QoL score of each key domain of QoL was higher in nurse led care group when compared to oncologist led care group. Overall, significant improvement in quality of life was observed in individuals underwent in nurse led care group than oncologist led care group. ConclusionThe results of this preliminary study showed that NLC results in better clinical outcome in terms of improvement in pain intensity, dyspnea intensity, symptom distress, constipation score, and QOL in comparison to oncologist led care among Chinese cancer patients. This study results can aid as a base for steering outsized clinical study to form the model of NLC among Chinese cancer patients.

Comparison of Taiji and aerobic exercise for functional constipation: study protocol for a randomised controlled neuroimaging trial

IntroductionTaiji has been proven to be effective for regulating both the physical and mental state compared with simple aerobic exercise. However, whether the improvement of Taiji for constipation is related...

More opioids, more constipation? Evaluation of longitudinal total oral opioid consumption and self-reported constipation in patients with cancer.

Opioid-induced constipation (OIC) is a distressing physical symptom for patients with cancer taking opioids. Total opioid consumption may contribute to developing worsening OIC-related symptoms. We completed a retrospective analysis examining the association of total daily opioid consumption on self-reported constipation in patients with cancer. In over 5 clinic visits, we collected self-reported constipation scores and 24-h oral morphine equivalents (OME). We examined the association between OME and the presence of constipation (i.e., score >3) and the relationship of OME between patients with or without constipation. Of 297 patients with cancer, we observed 57.8% with constipation and 42.4% without constipation at the first clinic visit. Age was similar in both groups (54.2 ± 14.5 vs. 56.4 ± 14.8years [mean ± SD]) and the majority of patients were women (63.7% vs. 61.1%). The most common cancer type in patients with constipation was non-colorectal gastrointestinal (n = 25, 14.6%), while in patients without constipation was colorectal gastrointestinal (n = 25; 19.8%). Across visits, we observed weak or no association between OME and self-reported constipation (r = 0.01-0.27). At the first visit, higher mean OME was seen in patients who self-reported constipation (133.4 vs 76; p < 0.05). Age, sex, metastatic disease, and stimulant laxative use were not associated with constipation. We observed weak to no association between OME and constipation in patients with cancer. These results suggest a lack of a clear association between total opioid consumption and self-reported constipation.

Sacral nerve stimulation in slow-transit constipation: effectiveness at 5-year follow-up.

The aim of this study is to evaluate the short- and long-term efficacy of sacral nerve stimulation (SNS) for treating slow-transit constipation (STC). This is a retrospective cohort analysis of the efficacy of SNS in treating patients affected by STC, who previously failed to respond to conservative therapies. Only patients free of concomitant diseases were enrolled in our study. A temporary stimulation lead was initially implanted; patients with a > 50% symptom reduction were eventually deemed eligible for a permanent implant. This study enrolled 25 patients who underwent a SNS test stimulation; 21 patients (13 women; median age 32years) eventually got a permanent implant. The median preoperative Cleveland Clinic Constipation Score (CCCS) was 21 (16-25). Preoperative colorectal transit time recorded a median of 10 markers (7-19) retained in the colorectal tract. At 6-month postoperative follow-up, the total number of markers retained in the colorectal tract decreased to 3 (0-4). The CCCS score improved during the first postoperative year (P < 0.001), but progressively worsened over the longer term. The SF-36 questionnaire showed an improvement in all 8 scales measuring physical and psycho-emotional states; all parameters recorded into the bowel diary also improved. Overall, at 60-month follow up, the overall neuromodulator removal rate was 48%. The SNS is a minimally invasive surgical procedure that we tested for treating STC. The short-term outcome was promisingly after 6months; however, there was a declining trend beyond this interval. Thus, the long-term efficacy of SNS needs to be further assessed.

STARR Operation in Management of Patients with Rectal Intussusception: Short Term Results

Aim: To evaluate the safety and efficacy of stapled transanal rectal resection (STARR), and its short -term outcomes (12- month) in patients with obstructive defectaion caused by rectal intussception. Patients and methods: A prospective observational study was performed including 25 women with rectal intussusception who underwent STARR in the period from April 2017 to March 2018. Data were collected prospectively from standardized questionnaires for the assessment of constipation [constipation scoring system, Longo’s obstructed defecation syndrome (ODS) score system, symptom severity score], patient satisfaction and quality of life (Patient Assessment of Constipation-Quality of Life Questionnaire). Results: The preoperative status, perioperative and postoperative complications at baseline 3, 6 and 12 months were assessed. At a 12-months follow-up, a significant improvement in the constipation scoring system, ODS score system, symptom severity score, and quality of life was observed. The self-reported definitive outcome was excellent in 8 (30%) patients, fairly good in 4 (16%), good in 11 (44%), and poor in 2 (10%). Conclusion: STARR can be performed safely without major morbidity and with very good short-term results in treating patients with obstructed defecation from rectal intussusception

Functional Outcome After Laparoscopic Posterior Sutured Rectopexy versus Ventral Mesh Rectopexy for Rectal Prolapse: Six-Year Follow-Up of a Double-Blind, Randomised Single-Centre Study

Background: Laparoscopic ventral mesh rectopexy (LVMR) for rectal prolapse has been widely adopted over the last decade with an intention to reduce postoperative functional bowel symptoms. The preoperative-to-postoperative change in short-term functional results in a double blinded, randomized study comparing it to laparoscopic posterior suture rectopexy (LPSR) has shown no significant difference between the two procedures after one year. The aim of the present study was to investigate the long-term functional outcomes. Methods: From November 2006-January 2014, a total of 75 patients were randomized to LVMR (n=37) or LPSR (n=38). In March 2017, questionnaires containing constipation symptom score (PAC-SYM), quality of life score (PAC-QoL), obstructed defecation score (ODS), Cleveland clinic constipation and incontinence scores (CCCS,CCIS) were mailed to all the patients included in the randomized trial to assess the long-term functional outcome. Prolapse recurrences and mesh complications were recorded. Finding: Sixty-nine patients were available for long-term follow-up. The questionnaires were completed by 64 patients (94·4%). The median followup was 6·1 years in the two groups. The total PAC-QoL was significantly lower in the LVMR group 0·26 (0·14-0·83) compared to the LPSR group 0.93 (0·32-1·61) (P=0·008). The total PAC-SYM was significantly lower in the LVMR group 0.5 (0·21-0·87) compared to the LPSR group 1.0 (0·5-1·5) (P=0·031). The ODS and the CCCS were significantly in favor of the LVMR group at six years (P=0·011 & 0·017). However, there was no difference at six years follow-up in CCIS between the two groups. Only three (8·82%) patients in the LVMR group developed recurrence compared to seven (23·33%) in the LPSR group (P=0·111). None of the patient developed mesh-related complication or re-operation. Interpretation: The long-term functional outcome after LVMR is superior to that after LPSR with a trend toward a lower recurrence rate. Larger multi-centre studies are warranted to validate these results. Previous Trial Registration: The randomized controlled study was approved by the Danish Ethical Committee (reference number M-AA-20060096) and the Danish Data Protection Agency. Informed consent was obtained from all patients according to the Declaration of Helsinki. Funding Statement: The authors stated: The study was conducted as a part of routine clinical work and no funding was received. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: This long-term follow up study was classified as a quality project and a new approval from the Ethical Committee was not needed according to Danish regulations.

Severe Constipation in Parkinson's Disease and in Parkinsonisms: Prevalence and Affecting Factors.

Background: constipation is one of the most common and disabling non-motor symptoms of Parkinson Disease (PD) and Parkinsonisms (PS). Few studies evaluate the difference of prevalence between PD and PS and the cause leading to a severe constipation in this diseases.Objective: Aim of our study is to evaluate the prevalence of constipation in a population of patients with PD and PS and to evaluate which factors influence the development of severe constipation.Methods: Two hundred and fifty outpatients with PD and 39 with PS were enrolled. Sixty five age-matched healthy subjects served as control. Constipation was assessed using the “Constipation Scoring System” (CSS). All patients underwent a global clinical, functional and neuropsychological assessment including: Unified Parkinson's disease Rating Scale (UPDRS), 6-min Walk Test (6MWT), and Mini-Mental State Examination (MMSE).Results: Data confirm the high prevalence of constipation among patients with PD and PS. Severe constipation affects much more patients with PS. A significant association between total CSS and age, H and Y stage, 6MWT, MMSE, total UPDRS, and UPDRS III was found in PD. In PS patients total CSS was associated with age, 6MWT, total UPDRS, and UPDRS III. Multivariable regression analysis showed that the only variables significantly and independently associated with total CSS in PD patients were age and total UPDRS, both with direct relationship.Conclusions: The reduction of motor performance seems to be the primary cause for developing severe constipation in PD and PS patients. These data suggest that maintain a good quality of gait and endurance may be helpful to reduce the risk of constipation.

Short term outcome of laparoscopic ventral mesh rectopexy for rectal and complex pelvic organ prolapse: case series.

Laparoscopic ventral mesh rectopexy (LVMR) is a technique gaining more recognition for the management of pelvic floor disorders, such as external rectal prolapse (ERP), high grade internal rectal prolapse (IRP) and rectocele. LVMR also allows correction of coexisted pelvic organ prolapse. This study aimed to evaluate the safety, efficacy and functional outcome of LVMR for rectal and complex pelvic organ prolapse. All patients who underwent LVMR from February 2014 to October 2017 were included into the study. The patients were evaluated preoperatively and three months postoperatively. Surgical complications and functional results in terms of fecal incontinence (measured with the Wexner Incontinence Score= WIS) and constipation (measured with the Wexner Constipation Score= WCS) were analyzed. Thirty (4 males) patients underwent LVMR. Seventeen (56.6%) patients had complex pelvic organ prolapse according to MRI findings. Median operative time and postoperative stay were 110 minutes and 4 days, respectively. No mesh-related complication and recurrence were observed. Before surgery, 21 (70%) patients had complained about symptoms of obstructed defecation. WCS decreased significantly from median 19 to 6 (p <0.001). Preoperative median WIS of 9 patients was 14 and went down to 6 postoperatively (p= 0.008). WCS significantly improved after LVMR in patients with symptomatic rectocele combined with enterocele or sigmoidocele (p= 0.005), and significant improvement was also observed in patients with symptomatic rectocele combined with gynecologic organ prolapse, preoperative median WCS was 18 and the postoperative value fell to 8 (p= 0.005). LVMR is an effective surgical option for rectal and complex pelvic organ prolapse with short-term follow-up.