Wexner Constipation Score Research Articles

Anatomical and functional outcomes of rectal prolapse treatment with laparoscopic pelvic organ prolapse suspension versus laparoscopic ventral mesh rectopexy

AbstractAimVery few studies have compared laparoscopic pelvic organ prolapse suspension (POPS) and laparoscopic ventral mesh rectopexy (LVMR) in the treatment of rectal prolapse, particularly regarding the comparison of improvement rates in obstructed defecation syndrome (ODS). This study aimed to compare the anatomical and functional outcomes of these two methods over a long‐term follow‐up period.Patients and methodsThis retrospective study was conducted on 120 female patients diagnosed with rectal prolapse who underwent surgery at the Colorectal Surgery Department of Shahid Faqihi Hospital in Shiraz, Iran, between October 2015 and October 2022. The patients were categorised into two groups based on their surgical procedures: 58 underwent LVMR in the first group, and 62 underwent POPS in the second group.ResultsRecurrence of prolapse occurred in 7 (12.1%) patients in the LVMR group and 5 (8.1%) patients in the POPS group (P = .550). The mean operation time, mean length of hospital stay, Visual Analogue Scale score, early and late post‐operative complications, Cleveland Clinic Incontinence Score, ODS symptoms, and Wexner Constipation Scores did not differ significantly between the two groups.ConclusionBoth laparoscopic POPS and LVMR techniques significantly improved the anatomical and functional outcomes in the treatment of rectal prolapse and obstructed defecation. LVMR and POPS can each be considered first‐line treatment options for rectal prolapse, depending on the specific case.

Factors predict prolonged colonoscopy before the procedure: prospective registry study.

Colonoscopy difficulty and procedure time can vary between cases, posing challenges for daily scheduling in endoscopy units. In the literature, cecal intubation time (CIT) is commonly used to assess colonoscopy difficulty, yet there is debate regarding the factors influencing CIT. This prospective observational study aimed to evaluate the factors influencing CIT. In this single-center, prospective, observational study, 915 patients who underwent colonoscopy between July 2023 and April 2024 were evaluated. Failure to achieve cecal intubation due to poor bowel preparation and a history of colorectal surgery were considered as exclusion criteria. Patients with a CIT ≥ 11min or those with technically failed cecal intubation were categorized into the prolonged CIT subgroup, while those with a CIT < 11min were analyzed in the normal CIT subgroup. Patients were evaluated based on demographic characteristics, clinical parameters, and colonoscopy results. A total of 902 patients included in the final analysis. The median age was 55years and 55.4% of them were women. The cecal intubation rate was 97.5% (892 patients). The polyp, adenoma, and malignancy detection rate were 27.4, 20.7, and 1.9%, respectively. Median cecal intubation time (CIT) was 6min (Interquartile range: 4-8). In multivariate analysis, body mass index ≤ 18.5, previous abdominal surgery, increased Wexner Constipation Score, and lesser endoscopist experience were associated with prolonged CIT. BMI, previous abdominal surgery, severity of constipation, and the experience of endoscopist may affect CIT. Considering these factors during daily planning in the endoscopy unit can lead to more efficient facility utilization.

The association of fecal incontinence, constipation, and pelvic pain with the course of lower urinary tract symptoms in community-dwelling men and women.

Fecal incontinence, constipation, and pelvic pain are common pelvic floor symptoms (PFS), and frequently coexist with lower urinary tract symptoms (LUTS). However, their association with the longitudinal trajectory of LUTS have not been well described. Our objective was to investigate the association between PFS and the course of LUTS in community-dwelling men and women. Men and women aged ≥16 years were invited to participate in a prospective observational cohort study. At baseline, and after 12 and 24 months, participants filled in the International Consultation on Incontinence Modular Questionnaire (ICIQ-MLUTS and ICIQ-FLUTS) for men and women respectively, the Wexner incontinence and constipation scale, and a questionnaire on pelvic pain. Generalized estimating equations were used to examine the association between change scores in defecation problems and pelvic pain, and LUTS change scores. A total of 694 men and 997 women gave informed consent, with 417 men and 566 women included in the analysis. The mean age was 63.2 ± 12.7 years for men and 58.6 ± 14.8 years for women. The study showed minor changes in LUTS scores over the 0-12 and 12-24-month periods. Generalized estimating equations revealed positive associations between changes in constipation and fecal incontinence and LUTS changes in both sexes. For instance, a one-point increase in Wexner constipation score was associated with 0.376 (0.165, 0.587) points higher LUTS change in men and 0.223 (0.109, 0.336) points in women during the 0-12-month follow-up. However, associations between changes in pain and LUTS scores varied across sexes and time periods. We observed minor changes in LUTS over time and weak associations between PFS and LUTS that sometimes differed between males and females, emphasizing the need for sex-specific considerations. These insights can provide valuable guidance for the development of targeted prevention trials, ultimately aiming to enhance overall pelvic health and patient well-being.

Ileorectal intussusception compared to end-to-end ileorectal anastomosis after laparoscopic total colectomy in slow-transit constipation

BackgroundAlthough end-to-end ileorectal anastomosis (EEIRA) following total colectomy is the most effective surgical treatment for slow-transit constipation (STC), frequent diarrhea and urgent defecation is often not resolved for over 6 months after surgery. ObjectiveThis study aimed to compare defecating frequency, surgical complications, and quality of life after ileorectal intussusception anastomosis (IRIA) or EEIRA following laparoscopic total colectomy for treatment of STC. MethodsThis is a retrospectively collected and analyzed data set of 100 patients with consecutive STC treated by the same medical team at Tianjin Union Medical Center from August 2016 to July 2021. Out of 100, 70 cases underwent IRIA, and 30 cases underwent EEIRA. The incidence and mortality of postoperative complications, gastrointestinal quality of life score (GIQLI), and fecal incontinence quality of life score (FIQL) were assessed at a median 3-year postoperative follow-up. The frequency of defecation, use of antidiarrheal drugs, and Wexner constipation score were assessed at the 12-month follow-up. ResultsA total of 100 patients (83 women and 17 men) were enrolled; no patients died during the study. At the 12-month follow-up, 19 patients (19/30, 63,33%) in the EEIRA group defecated >10 times after surgery. At 7 days, 1 month, 2 months, 3 months, 6 months, and 12 months after operation, there were statistically significant reductions in defecation times in the IRIA compared to the EEIRA group (all P < 0.05). ANOVA showed that the number of defecations decreased significantly in the IRIA compared to the EEIRA group (P < 0.00). Follow-up at the a median of three years showed a significant difference in the prevalence of short-term (P = 0.03) and long-term complications (P = 0.01) between the IRIA and EEIRA groups. The IRIA group had significantly improved FIQL (P = 0.03) and GIQLI scores (P = 0.01) compared to the EEIRA group at the median 3-year postoperative follow-up. ConclusionsAfter a median of three years, IRIA results in a lower prevalence of surgical complications than EEIRA and significantly improves the quality of life for STC patients by reducing defecation frequency within 12 months postoperatively.

Effectiveness of a Multispecies Synbiotic on Functional Constipation: A Randomized Controlled Trial

Background: Changes in the intestinal microbial flora may contribute to the occurrence and intensification of functional constipation (FC). Probiotics have shown promise as a potential alternative treatment for constipation. Objectives: The main goal of this study is to assess the effects of an Iranian multispecies synbiotic supplement on FC. Methods: This randomized controlled trial (RCT) recruited 115 adult patients who met the Rome IV criteria for FC after fulfilling the inclusion criteria. They were randomly assigned to receive either psyllium (n = 57) or psyllium plus synbiotic (n = 58) daily for 4 weeks. The treatment response was evaluated based on changes in stool consistency (based on the Bristol scale), bloating severity, and constipation intensity (based on the Wexner Constipation Scoring System), and those with a partial to excellent response were considered treatment successes. Results: The two groups did not differ in terms of sex, age, and BMI. The downward trend of stool consistency, bloating, as well as, constipation intensity was significant after 2 weeks of synbiotic-containing intervention. Treatment success after 4 weeks was 75.44% in the synbiotic group, compared to 30.91% in the psyllium-alone group (P &lt; 0.001), indicating the superior efficiency of the synbiotic. Neither treatment exhibited adverse effects (P = 0.924), although psyllium was found to be less tolerable than the synbiotic (P = 0.026). Conclusions: Multispecies synbiotic intake for 4 weeks may be a promising treatment option for FC, given its striking favorable effects on constipation severity, safety, and tolerability.

Degree of transverse colon ptosis: an alternative surrogate for evaluation of slow transit constipation.

Although transverse colon ptosis (TCP) is commonly diagnosed in patients with constipation, it has not attracted significant attention in the evaluation of constipation. Herein, we assessed the correlation between TCP-related radiological parameters and the severity of slow transit constipation (STC). This study was a single-center retrospective cohort study, with participants enrolled between 2012 and 2020 in Zhongnan Hospital of Wuhan University, China. STC was diagnosed according to Rome IV criteria and results of colonic transit test (CTT); healthy volunteers were also recruited as controls. All participants were examined using abdominal X-rays (AXRs) to acquire the radiological parameters related to TCP. Among these parameters, the degree of TCP (DTCP) was defined as the vertical distance from the top of the splenic flexure to the lowest point of the reverse colon. The Wexner Constipation Score and Hospital Anxiety and Depression Scale were used to assess clinical severity. After multivariable linear regression, the correlations between radiological parameters and severity of STC were investigated. We also explored the differences in radiological parameters between the operation and the conservative group. The study included 139 patients with STC and 125 healthy people in as the normal control (NC). Patients with STC probably had larger DTCPs than those in the NC group (242.27±25.86 vs. 93.00±32.57 mm; P<0.001). Pearson correlation analysis showed that TCP-related parameters were consistent with the symptom severity of STC [e.g., parameter DTCP was strongly correlated with Wexner Constipation Score, with a β coefficient (95% CI) of 8.63 (8.24-9.02), P<0.001]. Multivariable linear regression models showed that patients with a larger DTCP were more likely to undergo surgery (23.67; 95% CI: 1.40-45.94; P=0.04). TCP-related parameters, especially the DTCP, may serve as novel and feasible alternative indices for the assessment of STC. However, the potential value of DTCP in assisting the evaluation of STC needs to be confirmed in study with a larger sample size.

Efficacy of washed microbiota transplantation for therapeutic targets of refractory functional constipation and the influencing factors: a single-center, retrospective, 24-week follow-up study

BackgroundThe efficacy of washed microbiota transplantation (WMT) in terms of refractory functional constipation (FC)-related therapeutic targets and influencing factors have not been elucidated. This study aimed to assess the efficacy and influencing factors of WMT in treating refractory FC-related therapeutic targets.MethodsThe clinical data of patients diagnosed with refractory FC and received with WMT were retrospectively collected. The therapeutic targets included straining, hard stools, incomplete evacuation, a sense of anorectal obstruction, manual maneuvers, and decreased stool frequency. Each target was recorded as 1 (yes) or 0 (no). All patients were followed up for approximately 24 weeks from the end of the first course of WMT. The primary outcomes were the improvement rates for the individual therapeutic targets and the overall response in respect of the therapeutic targets decreased by 2 at weeks 4, 8, and 24. The secondary outcomes were the clinical remission rate (i.e., the proportion of patients with an average of 3 or more spontaneous complete bowel movements per week), clinical improvement rate (i.e., the proportion of patients with an average increase of 1 or more SCBMs/week or patients with remission), stool frequency, Wexner constipation score, Bristol Stool Form Scale (BSFS) score, and adverse events. The factors influencing the efficacy were also analyzed.ResultsOverall, 63 patients with 112 WMT courses were enrolled. The improvement rates at weeks 8 and 24 were 45.6% and 35.0%, 42.9% and 38.6%, 45.0% and 35.7%, 55.6% and 44.4%, and 60.9% and 50.0%, respectively, for straining, hard stools, incomplete evacuation, a sense of anorectal obstruction, and decreased stool frequency. The overall response rates were 49.2%, 50.8%, and 42.9%, respectively, at weeks 4, 8, and 24. The rates of clinical remission and clinical improvement were 54.0% and 68.3%, respectively, at weeks 4. The stool frequency, BSFS score, and Wexner constipation score tended to improve post-WMT. Only 22 mild adverse events were observed during the 112 WMT courses and the follow-up. The number of WMT courses was identified to be the independent factor influencing the efficacy.ConclusionsWMT is efficacious in improving refractory FC-related therapeutic targets. The effectiveness of WMT in the management of FC is enhanced with the administration of multiple courses.

Moxibustion treatment for Parkinson’s disease: study protocol for a randomized controlled trial

BackgroundParkinson’s disease (PD) is the second most common neurodegenerative disorder and seriously affects quality of life globally. Moxibustion is widely used to treat neurodegenerative diseases in the clinic and has achieved a beneficial clinical effect. However, strict control and high-quality randomized controlled trials are still lacking. Therefore, this trial aims to evaluate the clinical efficacy and safety of moxibustion in patients with PD and preliminarily explore the underlying mechanism.MethodsThis is a randomized, single-blind and placebo-controlled trial design in which 70 eligible participants will be randomly divided into a moxibustion group and a sham moxibustion group. Baihui (DU20) and Sishenchong (EX-HN1) are selected for both groups. The treatment will be performed for 30 min per session, two sessions a week for 8 weeks. The mean change in MDS-UPDRS scores (including MDS-UPDRS II, III subscale scores and total scores) from baseline to the observation points will be the primary outcome. The secondary outcomes will include scores on the Parkinson’s Disease Questionnaire-39 (PDQ-39), Fatigue Severity Scale (FSS), Parkinson Disease Sleep Scale (PDSS), Montreal Cognitive Assessment (MoCA), and Self-Rating Depression Scale (SDS) as well as the Wexner constipation score. All the above outcomes will be assessed at 4 and 8 weeks. Laboratory blood biochemical analysis and functional magnetic resonance imaging (fMRI) will be conducted at baseline and at the end of treatment to explore the potential mechanisms of moxibustion in regulating PD.DiscussionIn conclusion, the results of this trial will reveal whether moxibustion is effective for treating motor and nonmotor symptoms in PD. This trial will also preliminarily explore the underlying mechanism of the regulatory effect of moxibustion in PD, which will contribute to providing a theoretical basis for the treatment of PD.Trial registrationClinicalTrials.gov ChiCTR2000029745. Registered on 9 August 2021.

Dopamine transporter binding in the brain is linked to irritable bowel syndrome in Parkinson's disease.

Gastrointestinal symptoms are common in Parkinson's disease (PD), but their neurophysiological correlates are not well understood. We recently reported that functional gastrointestinal symptoms were not associated with asymmetry per se but might be associated with lower left striatal dopamine transporter (DAT) binding. The purpose of this study was to further investigate if specific gastrointestinal symptoms associate with monoamine transporter changes in specific striatal or extrastriatal areas. Ninety PD patients, who underwent DAT ¹2 3 I-FP-CIT SPECT imaging, were assessed using the MDS-Unified Parkinson's Disease Rating Scale part III, Rome III, and Wexner constipation score. DAT binding was calculated from striatal subregions using region-to-occipital cortex ratio. Voxel-wise analysis was used to assess the relationship between gastrointestinal symptoms and striatal DAT and extrastriatal serotonin transporter (SERT) binding. Irritable bowel syndrome (IBS) criteria were fulfilled in 17 patients and were linked to higher ¹2 3 I-FP-CIT binding in the right posterior putamen and adjacent areas as compared to patients without IBS. No other significant associations between gastrointestinal symptoms and DAT or SERT binding were found. These findings suggest that PD patients with IBS may have higher DAT binding in the right hemisphere. This finding implicates alterations of brain neurotransmitter physiology in the gastrointestinal symptoms of PD patients.

Robotic-assisted rectosigmoid resection rectopexy with natural orifice specimen extraction (NOSE): technical notes, short-term results, and functional outcome

Rectosigmoid resection rectopexy has been established as an effective therapy for obstructive defecation syndrome. The addition of the NOSE-technique provides an even less invasive approach avoiding minilaparotomy, but can be technically challenging. Application of a robotic platform has been proposed to facilitate the specimen extraction and fashioning of the intracorporeal anastomosis and has been proven to be effective in left-sided colectomies. After establishing laparoscopic rectosigmoid-resection-rectopexy with NOSE, we modified our technique by addition of the robotic platform. Whenever robotic capacity was available, elective patients scheduled for rectosigmoid resection rectopexy for obstructive defecation syndrome were operated robotically assisted. Demographic and intraoperative data were prospectively collected. Follow up was assessed using the Wexner constipation score, Wexner incontinence score, and Altomare ODS score. The NOSE-RRR technique was completed in all 31 patients. The mean operative time was 166 min (range 67-230). No conversion was required. The median hospital stay was 5 days (range 3-28). Four patients had minor complications (Clavien I). Two patients were reoperated (Clavien IIIb). Functional scores improved significantly postoperatively. Mean Wexner incontinence score was 7.1 preoperatively, 6.9 after 1 month, and decreased significantly to 3.93 after 3 months (p < 0.001). Mean Altomare ODS score was 17.47 preoperatively and 6.93/5.03 after 1/3 months (p < 0.001). Wexner constipation score (12.83) also showed a significant improvement after 1/3 months (6.97/6.67; p < 0.001). NOSE-RRR can be performed safely with a low rate of manageable complications. The technique provides a significant improvement for ODS-Symptoms.

A comparative study between transanal and transabdominal approaches in treatment of complete rectal prolapse

There is a wide variety of surgical methods to treat rectal prolapse; however, to date, no clear agreement exists regarding the most effective surgical method. This study was designed to compare the results according to the surgical approach for complete rectal prolapse in women. This study was conducted from March 2016 to February 2021 on female patients with rectal prolapse who underwent surgery. First, all patients were classified into mucosal and complete layer groups to confirm the difference in results between the two groups, and only complete layer prolapse patients were divided into transanal and abdominal approaches to compare parameters and functional outcomes in each group. A total of 180 patients were included, with an average age of 71.7 years and 102 complete prolapses. The complete layer group was found to have more abdominal access, longer operating time, and higher recurrence rates compared to the mucosal layer group. (p<0.001) When targeting only the complete layer patients, there were 65 patients with the transanal and 37 with the abdominal (laparoscopic) approaches. The abdominal approach group had a longer operating time and hospital stay (p<0.001, respectively) and lower recurrence rate than the transanal group (transanal vs. abdominal, 38% vs. 10.8%, p=0.003), while the Wexner constipation and incontinence scores showed improved results in both groups. Although operating time and hospitalization period were shorter in the transanal group, laparoscopic abdominal surgery is a procedure that can reduce the recurrent rate for complete rectal prolapse.

Prevalence of Obstructed Defecation among Patients Who Underwent Hemorrhoidectomy and Correlation between Preoperative Constipation Score and Postoperative Patients' Satisfaction: A Prospective Study in Two Centers.

obstructed defecation syndrome (ODS) is a common but underestimated condition that may affect the outcomes after hemorrhoidectomy. Therefore, the aim of this study was to determine the prevalence of obstructed defecation syndrome (ODS) among patients who underwent hemorrhoidectomy and to assess the correlation between preoperative constipation score and postoperative patients' satisfaction. This prospective study included adult patients who underwent hemorrhoidectomy for 3rd and 4th-grade hemorrhoidal diseases. All participant patients underwent an assessment of functional OD severity by the Agachan-Wexner Constipation Scoring System. All patients were subjected to conventional hemorrhoidectomy. At 6 months postoperatively, patients were assessed again for their constipation score and postoperative patients' satisfaction. The study included 120 patients (62 males and 58 females) with a mean age of 38.7 ± 12.1 years. About one-quarter of patients (24.2%) had obstructed defecation (constipation score ≥12). ODS (constipation score ≥12) was found to be significantly more among older patients, female patients, especially those with multiple pregnancies and multiple labors, and those with perineal descent. The postoperative constipation score (5.6 ± 3.3 mean ± SD) showed significant improvement (p = 0.001) compared to (9.3 ± 3.9 mean ± SD) preoperatively. Postoperative patients' satisfaction (mean 12.3 ± 3.0) at 6 months had a negative correlation with preoperative total constipation score (r = -0.035, p = 0.702). The prevalence of obstructed defecation among patients with hemorrhoids was higher than reported among the general population. High preoperative constipation scores had a negative correlation with postoperative patients' satisfaction. Routine preoperative measurement of ODS can allow the detection of this particular group of patients who require a more physical and psychological evaluation, in addition to special preoperative counseling.

Habitual Dietary Fibre Intake and Lifestyle Characteristics in Relation to Functional Constipation Among Adults in Malaysia

The World Health Organization (WHO) and the Food and Agriculture Organization (FAO) recommend consuming at least 25 g of dietary fibre daily. Adults with low fibre intake have an increased constipation risk. However, little research has been done on the habitual dietary fibre intake and lifestyle characteristics of functional constipation in Malaysian adults. Thus, the purpose of this study is to determine the dietary fibre intake, lifestyle characteristics, and functional constipation of adults in Malaysia, as well as the association between habitual dietary fibre intake, lifestyle characteristics, and functional constipation. About 318 adults between the ages of 18 and 59 participated and were asked to complete an online questionnaire consisting of three major parts. The components are as follows: i) the assessment of dietary fibre intake by using a semi-quantitative dietary fibre food frequency questionnaire; ii) the assessment of lifestyle factors; and iii) the determination of functional constipation via the Wexner Constipation Scoring System. SPSS 25 was used to analyse the data at a significance level of 0.05. The results indicated that the majority of adults consumed dietary fibre in amounts less than 25 g per day (84.6%). About 97.5% of adults have a healthy lifestyle, and only 2.8% of adults in this study faced constipation. There was no significant association between habitual dietary fibre intake and lifestyle characteristics (p=0.614) or between habitual dietary fibre intake and functional constipation among adults in Malaysia (p=0.147). Continued efforts are needed to increase dietary fibre intake among the adult population.

Cap-assisted endoscopic sclerotherapy is effective for rectal mucosal prolapse associated outlet obstructive constipation

Background and study aimsOutlet obstructive constipation (OOC) is a common type of chronic constipation that is usually caused by internal hemorrhoids (IH) and rectal mucosal prolapse (RMP). Cap-assisted endoscopic sclerotherapy (CAES) was demonstrated to be effective in the treatment of IH and RMP. This study explored the efficacy of CAES in treating OOC associated with IH and RMP. MethodsThirty-one patients (15 males and 16 females) were diagnosed with OOC after colonoscopy and anorectal manometry (AM). CAES was used to treat IH and RMP. The self-rating anxiety scale (SAS), self-rating depression scale (SDS), and Wexner constipation score (WCS) were used to assess patients at baseline and at the end of follow-up. AM tests were performed before and after CAES. ResultsThe mean age of patients was 56.19 ± 7.969 years, and the follow-up time was 2.875 ± 3.703 months. After CAES treatment, subjective indices, including frequency of bowel movements (p < 0.05), defecation time (p < 0.05), SAS (p < 0.05), SDS (p < 0.05), and WCS (p < 0.05), were significantly improved. AM showed that the anal relaxation rate (p < 0.05), maximum squeeze pressure (p < 0.05), and rectal residual pressure (p < 0.05) were significantly improved. The ratio of Bristol stool form scale typeIII–Vincreased from 12.5 % to 56.25 % (p < 0.05). ConclusionsCAES is effective for treating OOC caused by IH and RMP. The relief of OOC symptoms could improve anxiety and depression symptoms associated with the disease.

8795 Impact of Surgical Procedures on Intestinal Function and Quality of Life in Patients with Deep Endometriosis: A Prospective Study

<h3>Study Objective</h3> To analyze the prevalence of intestinal discomforts in patients with deep endometriosis (DE) and the alteration of different surgical procedures on their intestinal function and quality of life at short-term follow-up. <h3>Design</h3> A prospective cohort study. <h3>Setting</h3> A university-based tertiary obstetrics and gynecology hospital. <h3>Patients or Participants</h3> Patients with deep endometriosis infiltrating the rectum treated in the same medical team since April 1, 2018. <h3>Interventions</h3> Patients underwent rectal shaving, disk excision or segmental bowel resection depending on the severity of DE. <h3>Measurements and Main Results</h3> The primary end point was the prevalence of intestinal discomforts, pain symptoms ranked by VAS (visual analogue score). The secondary end points were values of gastrointestinal questionnaires, including GIQLI(gastrointestinal quality of life index), Wexner constipation score, CRADI-8 (colorectal-anal distress inventory 8),and SF 36 to evaluate quality of life. As of March 15, 2019,88 patients were enrolled, including 58 patients in group rectal shaving, 25 in disk excision and 5 in segmental bowel resection.59.04% (49/88) of patients had intestinal symptoms preoperatively, manifested as menstrual diarrhea 26(53.06%), bulge 19(38.78%)and hematochezia 13 (26.53%). However, postoperatively, the discomforts were mainly caused by diarrhea 10.23% (9/17) at 1-month follow-up(V1), constipation 40% (4/10) at 6-month follow-up(V6). According to the follow-up, there are significant improvement in dysmenorrhea in all three group, but the improvement of intestinal discomfort only in group shaving were significant 0(0,2) vs 0(0,0) at V1 and 0(0,2) vs 0(0,0) at V6,<i>P</i><0.05,respectively.Patients in group shaving had mild symptoms preoperatively, who had lower CRADI-8 and Wexner constipation scores than the other two groups. After surgical treatment, patients' gastrointestinal function were mild improved, but the SF-36 and the GIQLI score did not reach statistical significance among these 3 groups compared to the baseline. <h3>Conclusion</h3> For patients with complaints of periodic diarrhea, anal bulge and hematochezia, endometriosis should be considered. Although surgical procedures can improve patients' dysmenorrhea and intestinal discomfort, but, the occurrence of constipation in short term after surgery should be alert, especially in radical procedures.

The Prevalence of Constipation and Its Associated Complications in Aseer Region by Using Wexner Scale

Background: Constipation is a common condition in the community which represents a significant burden for both individuals and health care systems. For the individual, constipation is associated with pain and symptoms which negatively impact quality of life. Constipation is a common gastrointestinal problem, which causes many expenses for the community with an estimated prevalence of 1% to 80%, worldwide. Aim: to assess the prevalence of constipation and its associated complications in Asser region, Saudi Arabia, by using Wexner Constipation Scoring System. Methodology: A descriptive cross-sectional survey was used targeting all groups of population in Aseer region for at least 6 months, aged 18 years or more, and who agreed to participate in the study. Data was collected using structured questionnaire included person’s sociodemographic data, in addition to constipation severity as assessed using Wexner constipation scoring system. The final questionnaire was uploaded using social media platforms and answers were included consecutively till no more answers were obtained. Results: 939 participants completed the survey; 23.2% of participants had a score of (11-10) = mild constipation, and only 1.3% had a score (21-30) = moderate to severe constipation. The most common complications related to constipation and high Wexner score were: Hemorrhoid then hernia then rectal prolapse and anal fissure. In regard to most behaviors related to constipation and high Wexner score: change in daily routine was the highest correlated behavior with Wexner constipation score, followed by “smoking”. The clinical status related with constipation and high Wexner score: Chronic diseases and frequent use of medications. For marital status, being widowed or divorced was associated with a significantly higher score in Wexner constipation than being single or married. Doing exercises each day was associated with a lower score in Wexner constipation. Conclusions: In conclusion, the current study showed that chronic constipation was not a common health problem among the study population with higher severity score among old aged participants who were married and in the working group. Key words: Constipation, prevalence, population, Wexner score, risk factors, complications, Saudi Arabia.

Modified robotic ventral rectopexy with folded single titanized mesh suspension for the treatment of complex pelvic organ prolapse.

The incidence of complex pelvic organ prolapse in female patients is about 38%, and this disorder entails social and sexual restrictions. Treatment for this disorder is complex because it can enhance other, latent, problems. The aim of the present study is to describe a new robotic-assisted technique to simultaneously treat prolapses of different compartments with the use of a single titanized polypropylene mesh. All patients referred from January 2018 to March 2019 to the Proctologic and Pelvic Floor Clinical Centre who were affected by complex pelvic organ prolapse underwent modified robotic ventral rectopexy with a folded single mesh (RVR-FSM). The anatomical and functional outcomes were respectively evaluated using the Pelvic Organ Prolapse Quantification (POP-Q) grading system and Wexner scores of constipation and incontinence. The satisfaction rate was investigated using a five-point scale (1=not satisfied to 5=extremely satisfied). Twenty-two women underwent RVR-FSM with a homogeneous follow-up of 12 months. The mean total operation time was 148 min, without any robot-related or other intraoperative complications. No mesh-related complications occurred. The POP-Q grade improved for every patient, with complete resolution of bulging symptoms in 21 patients (95.4%) at 1year of follow-up. The Wexner constipation score showed a significant improvement, while the incontinence score slightly improved at 1year after surgery. The use of a single mesh that can be folded was shown to provide significant improvement in functional and anatomical results associated with patient satisfaction. The robotic approach allows surgeons to perform an easier procedure with correct and deep mesh fixation.

Predictive factors for functional failure of ventral mesh rectopexy in the treatment of rectal prolapse and obstructed defecation

BackgroundVentral mesh rectopexy (VMR) is widely accepted for the treatment of rectal prolapse or obstructed defecation. However, despite good anatomical results, the improvement of functional symptoms (constipation or incontinence) cannot always be obtained and in some cases these symptoms may even worsen. The aim of the present study was to identify possible predictors of functional failure after VMR.MethodsData of all consecutive patients who had VMR for the treatment of rectal prolapse and/or obstructed defecation between January 2017 and December 2020 in three different pelvic floor surgical centres in Italy were analysed to identify possible predictors of functional failure, intended as persistence, worsening or new onset of constipation or faecal incontinence. Symptom severity was assessed pre- and postoperatively with the Wexner Constipation score and Obstructed Defecation Syndrome score. Quality of life was assessed, also before and after treatment, with the Patients Assessment of Constipation Quality of Life questionnaire, the Pelvic Floor Disability Index and the Pelvic Floor Impact Questionnaire. Faecal incontinence was evaluated with the Cleveland Clinic Incontinence Score. The functional outcomes before and after surgery were compared.ResultsSixty-one patients were included (M:F ratio 3:60, median age 64 years [range 33–88 years]). Forty-two patients (68.9%) had obstructed defecation syndrome, 12(19.7%) had faecal incontinence and 7 patients (11.5%) had both. A statistically significant reduction between pre- and postoperative Obstructed Defecation Syndrome and Wexner scores was reported (p < 0.0001 in both cases). However, the postoperative presence of constipation occurred in 22 patients (36.1%) (this included 3 cases of new-onset constipation). The presence of redundant colon and the pre-existent constipation were associated with an increased risk of persistence of constipation postoperatively or new-onset constipation (p = 0.004 and p < 0.0001, respectively). The use of postoperative pelvic floor rehabilitation (p = 0.034) may reduce the risk of postoperative constipation.ConclusionsVMR is a safe and effective intervention for correcting the anatomical defect of rectal prolapse. The degree of prolapse, the presence of dolichocolon and pre-existing constipation are risk factors for the persistence or new onset of postoperative constipation. Postoperative rehabilitation treatment may reduce this risk.

Higher Symptom Score, Larger Residual Rectocele, and Lower Rectal Compliance Predict Failure of Improvement after Surgical Treatment of Rectocele

Abstract Background Rectocele is a frequent finding in women and is usually asymptomatic. However, it is sometimes associated with symptoms of obstructed defecation syndrome (ODS). While most patients with ODS due to rectocele respond well to conservative treatment, some may require surgical treatment. The aim of the study was to determine the predictors of failure of symptom improvement after rectocele repair. Methods The study included adult women with rectocele who underwent surgical treatment by transperineal repair (TPR) or transvaginal repair (TVR). The preoperative and postoperative assessment was done using the Wexner constipation score, anorectal manometry, and defecography. Results A total of 93 female patients with a mean age of 43.7 years were included. Among them, 65.6% of patients underwent TPR and 34.4% underwent TVR; 22 (23.7%) patients reported failure of significant improvement in ODS symptoms after surgery. The independent predictors of failure of improvement were higher preoperative Wexner score (odds ratio, OR: 1.4, 95% confidence interval, CI: 1.09–1.84, p = 0.009), larger residual rectocele after repair (OR: 2.95, 95% CI: 1.43–6.08, p = 0.003), and lower postoperative maximum tolerable volume (OR: 0.949, 95% CI: 0.907–0.992, p = 0.02). The predictive cutoff point for the preoperative Wexner score was 15. Conclusions Patients with a preoperative Wexner score higher than 15 and larger residual rectocele after surgery may experience little improvement in symptoms after rectocele repair. Although TPR was associated with a poorer relief of symptoms than did TVR; it was not an independent predictor of failure.

Native Tissue Posterior Compartment Repair for Isolated Posterior Vaginal Prolapse: Anatomical and Functional Outcomes.

Background and Objectives: Posterior compartment prolapse is associated with constipation and obstructed defecation syndrome. However, there is still a lack of consensus on the optimal treatment for this condition. We aim to investigate functional, anatomical, and quality-of-life outcomes of native tissue transvaginal repair of isolated symptomatic rectocele. Materials and Methods: We retrospective analyzed patients who underwent transvaginal native tissue repair for stage ≥ II and symptomatic posterior vaginal wall prolapse between January 2018 and June 2021. Anatomical and functional outcomes were evaluated. Wexner constipation score was used to assess bowel symptoms, while the Patient Global Impression of Improvement (PGI-I) score was used to evaluate subjective satisfaction after surgery. Results: Twenty-eight patients were included in the analysis. The median age was 64.5 years, and half of them underwent a previous hysterectomy for benign reasons. The median follow-up time was 33.5 months. A significant anatomical improvement in the posterior compartment was noticed compared with preoperative assessment (p < 0.001 for Ap and Bp), with only two (7.1%) anatomical recurrences. Additionally, obstructed defecation symptoms decreased significantly compared to baseline (p < 0.001), as well as vaginal bulging, with no new-onset cases of fecal incontinence or de novo dyspareunia. PGI-I resulted in 89.2% of patients being satisfied (PGI-I ≥ 2), with a median score of 1.5. Conclusions: Transvaginal native tissue repair for isolated posterior prolapse is safe and effective in managing bowel symptoms, with excellent anatomical and functional outcomes and satisfactory improvement in patients’ quality of life.