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- 王振宜主任医师 副教授
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医院:
上海中医药大学附属岳阳中西医结合医院
科室:
肛肠科
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- STARR & TRANSTARnew options for constipation associated w/ low rectal redundancy??2009年5月北京会议,法国pigot教授讲解,王振宜翻译
- 作者:王振宜|发布时间:2009-06-13|浏览量:1391次
François PIGOT, hôpital BAGATELLE, Bordeaux
Constipation ?
Rome II :
Excessive straining to defecate
Small and hard stools
Feeling of incomplete rectal evacuation
Anal obstacle
Manual assistance
< 3 stools a week
Constipation ?
Etiologies :
Obstructed defecation syndrome 上海岳阳医院肛肠科王振宜
Symptoms :
Extreme straining to defecate
Pain at defecation
Extended time at the toilet
Perineal pain/discomfort when standing
Feeling of incomplete evacuation
False urgency
Fragmented defecation
Vaginal, perineal or rectal digitation
Use of laxatives or enemas
Obstructed defecation syndrome
Etiologie for abnormal rectal function
Functional :
Pelvic dyssynergia
Rectal inertia
Prolapses :
Low rectal redundancy
Complex prolapses
ODS & low rectal redundancy
Therapeutic options :
Conservatives (medical, rehabilitation, biofeedback…)
Surgical
Rectopexy
Perineal mesh
Transanal rectal resection
Transanal rectal resection
STARR : double PPH 01
Diseases Colon Rectum 51: 1611?1618 (2008) : Outcomes of stapled Transanal Rectal Resection vs. Biofeedback for the Treatment of Outlet Obstruction Associated with Rectal Intussusception and Rectocele: A Multicenter, Randomized, Controlled Trial.
TranStar : contour transtar stapler
Pionners group and their role in surgeons formation
Patients selection
Results
Technique
Contour transtarr : update in EU
Ethicon Endo-Surgery policy
To prevent from misuses of the new Contour Stapler and to provide support to surgeons dealing with ODS
Constitution of an international group of experts
under supervision of A. Stuto the STARR Pioneers Group was constituted in 2006
Contour transtarr : update in EU
Missions of the Pioneers group :
Training of surgeons to Contour Stapler use
Evaluation of Contour TranSTARR procedure
Search for potential improvements in ODS and other pelvic floor diseases management
The STARR Pioneers
Stuto Angelo. Pordenone, Italy
Corbisier Fabrice. Charleroi, Belgium
Espin Basany Eloy. Barcelona, Spain
Hetzer Franc. St Gallen, Switzerland
Jayne David. Leeds, UK
Lenisa Leonardo. Milan, Italy
Nugent Karen. Southampton, UK
Pigot François. Talence, France
Scherer Roland. Berlin, Germany
Schwandner Oliver. Regensburg, Germany
Tuech Jean-Jacques. Rouen, France.
Contour TranSTARR training :
Surgeon used to transanal/perineal surgeon
aware of the 2PPH01 classical procedure.
Local EES counsellor
1 Hands-on training in Hamburg EES center
2 At home first operation under proctor supervision
Access to Contour TranStarr Stapler; +/- proctor
Key points for patients selection
Severe ODS & altered QoL/motivation to undergo further treatment
Patients who may be considered as suitable candidates for STARR should have failed conservative treatment
Standardized decision-making algorithm with special reference to anatomical findings (internal rectal prolapse +/- rectocele) is proposed
Decision-making Algorithm for the STARR procedure in Obstructed Defecation Syndrome:... Schwandner et al. Surg Innov.2008; 15: 105-109
Symptoms of ODS
Prolonged or repeated straining
Frequent calls to defecate prior to or following evacuation
Use of digital means to effect evacuation
Laxative or enema use required to defecate
Sense of incomplete evacuation
Excessive time spent on the toilet
Pelvic pressure, rectal discomfort, and perineal pain
Diagnostic Approach
Diagnostic Approach II
Diagnostic Approach III
Patient Exclusion Criteria
Active anorectal infection
Concurrent severe anorectal pathology
Proctitis (IBD, radiation)
Enterocele at rest (low, stable)
Chronic diarrhea
Relative exclusion criteria
Presence of foreign material adjacent to the rectum (i.e. mesh)
Previous transanal surgery
(i.e. rectal anastomosis)
Difficult evaluation (such as psychiatric disorder)
TranStar results
Feasibility study Demographics
Feasibility study
Feasibility study ODS Score
Feasibility study Jorge-Wexner Continence Score
Feasibility study Urgency
Incontinence
Conclusion
In well selected patients with ODS and low rectal deformity
After failure of conservative treatments
Transanal rectal resection (Star or TranStar) are valuable options
Few (if any…) other surgical alternatives are available.
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