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Klaus Ludwig - One of the best experts on this subject based on the ideXlab platform.
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Stapled transanal rectal resection under laparoscopic surveillance for rectocele and concomitant Enterocele.
Diseases of the colon and rectum, 2006Co-Authors: Sven Petersen, Gunter Hellmich, A. Schuster, D. Lehmann, W. Albert, Klaus LudwigAbstract:Stapled transanal rectal resection recently became a recommended surgical procedure for obstructed defecation syndrome. One problem when using a transanal stapling device for rectal surgery is the potential threat to structures located in front of the anterior rectal wall. We decided to perform a combined procedure of transanal rectal resection with a simultaneous laparoscopy for patients with obstructed defecation syndrome and an Enterocele. Between November 2002 and May 2005 a total of 41 patients were treated surgically for obstructed defecation syndrome. Four patients with concomitant Enterocele underwent stapled transanal rectal resection under laparoscopic surveillance. Before surgery all patients underwent preoperative assessment, including clinical examination, colonoscopy, conventional video defecography, dynamic magnetic resonance imaging defecography, gynecology examinations, and psychologic evaluation. The mean operative time was 50 (±16.5) minutes for the conventional stapled transanal rectal resection and 67 (±14.1) minutes for combined laparoscopy and stapled transanal rectal resection (P < 0.01). Three major complications were observed: two had bleeding in the staple line (one from each group) and one had a late abscess in the staple line. The combination of the stapled transanal rectal resection procedure and laparoscopy provides the opportunity to perform transanal rectal resection without the threat of intra-abdominal lesions caused by Enterocele.
C Isbert - One of the best experts on this subject based on the ideXlab platform.
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Enterocele is not a contraindication to stapled transanal surgery for outlet obstruction an analysis of 170 patients
Colorectal Disease, 2011Co-Authors: Joachim Reibetanz, L Boenicke, M Kim, C T Germer, C IsbertAbstract:Aim Enterocele is common among patients suffering from obstructive defecation syndrome (ODS), but it is often considered a contraindication for stapled transanal surgery. The functional results and complication rates were compared in patients with or without Enterocele who were treated with stapled transanal rectal resection (STARR) for ODS. Method Patients presenting with ODS were evaluated using standardized clinical and radiological investigations. A total of 170 patients were treated with either PPH01-STARR or Contour Transtar® and were followed up for a median of 18 months. Results On preoperative defecography, 55 (32%) of 170 patients were found to have an Enterocele. The preoperative Cleveland Clinic Constipation Scores (CCCS) in patients with and without Enterocele were (mean ± standard deviation) 15.9 ± 5.4 and 15.4 ± 5.2, respectively. At 18 months postoperatively the CCCS were 8.5 ± 2.7 and 8.1 ± 2.6 (P < 0.001), respectively, in patients with and without Enterocele. Morbidity was 7.3% (n = 4) in patients with Enterocele (anal pain, n = 1; minor bleeding, n = 2; and acute urinary retention, n = 1) and 7.0% (n = 8) in patients without Enterocele (anal pain, n = 3; minor bleeding, n = 3; acute urinary retention, n = 1; and staple line dehiscence, n = 1). There were no cases of pelvic sepsis, small bowel injury or postoperative ileus. No patient needed surgical re-operation. Conclusion There was no difference in functional outcome and postoperative complications in patients with and without Enterocele undergoing STARR for ODS.
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Enterocele is not a contraindication to stapled transanal surgery for outlet obstruction: an analysis of 170 patients.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2011Co-Authors: Joachim Reibetanz, L Boenicke, M Kim, C T Germer, C IsbertAbstract:Aim Enterocele is common among patients suffering from obstructive defecation syndrome (ODS), but it is often considered a contraindication for stapled transanal surgery. The functional results and complication rates were compared in patients with or without Enterocele who were treated with stapled transanal rectal resection (STARR) for ODS. Method Patients presenting with ODS were evaluated using standardized clinical and radiological investigations. A total of 170 patients were treated with either PPH01-STARR or Contour Transtar® and were followed up for a median of 18 months. Results On preoperative defecography, 55 (32%) of 170 patients were found to have an Enterocele. The preoperative Cleveland Clinic Constipation Scores (CCCS) in patients with and without Enterocele were (mean ± standard deviation) 15.9 ± 5.4 and 15.4 ± 5.2, respectively. At 18 months postoperatively the CCCS were 8.5 ± 2.7 and 8.1 ± 2.6 (P
A Carriero - One of the best experts on this subject based on the ideXlab platform.
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Laparoscopic correction of Enterocele associated to stapled transanal rectal resection for obstructed defecation syndrome
'Springer Science and Business Media LLC', 2010Co-Authors: A Carriero, Jacopo Martellucci, P Talento, Marcello Picchio, Domenico Palimento, Erasmo SpazianiAbstract:Background and aims: We report our experience of concomitant laparoscopic treatment for Enterocele and stapled transanal rectal resection (STARR) for rectocele and/or rectal prolapse in patients with complex obstructed defecation syndrome (ODS). Patients and methods: From June 2005 to June 2007, we submitted 20 patients with ODS due to rectal prolapse and/or rectocele, combined with stable Enterocele, to STARR and laparoscopic correction of the Enterocele. Preoperative assessment included symptom evaluation with standardized questionnaires, clinical examination, colonoscopy, proctoscopy, anal sphincter ultrasonography, video-defecography with synchronous opacification of the ileal loops in all patients and colpography in female patients, and anorectal manometry. Follow-up was performed in the first, third, sixth, 12th, and 24th month after surgery. Results: Eighteen (90%) patients were submitted to both procedures, simultaneously. One patient, previously submitted to STARR, underwent laparoscopic treatment of the Enterocele. Postoperative complications occurred in two (10%) patients: one case of postoperative rectal bleeding and one case of retropneumoperitoneum. Median (range) preoperative and postoperative Altomare's obstructed defecation score was ten (6-14) and two (0-14), respectively (p
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Laparoscopic correction of Enterocele associated to stapled transanal rectal resection for obstructed defecation syndrome
International journal of colorectal disease, 2009Co-Authors: A Carriero, Jacopo Martellucci, P Talento, Marcello Picchio, Domenico Palimento, Erasmo SpazianiAbstract:Background and aims We report our experience of concomitant laparoscopic treatment for Enterocele and stapled transanal rectal resection (STARR) for rectocele and/or rectal prolapse in patients with complex obstructed defecation syndrome (ODS).
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role of Enterocele in the obstructed defecation syndrome ods a new radiological point of view
Colorectal Disease, 2009Co-Authors: C Morandi, Jacopo Martellucci, P Talento, A CarrieroAbstract:Aim The aim of this study was to understand the role of Enterocele in the pathogenesis of the obstructed defecation syndrome (ODS) a new defecographic classification based on function. Method A total of 597 patients (551 women, 46 men) who underwent cinedefecography between November 2001 and November 2005 were studied. A total of 567 (95%) underwent cinedefecography as they had symptoms of ODS. Enterocele was classified into three types. Results Enterocele was found in 127 (23%) female and one (2.2%) male patients. Thirty-eight (6.9%) patients had type A, 38(6.9%) type B, and 27(4.9%) type C Enterocele. A total of 24 patients (4.35%) had sigmoidocele. In patients with type C Enterocele, the finding of a radiological pattern of ODS was higher (26/27) than that in the other groups (A + B + Sigmoidocele) (23/100) (P < 0.001). An obstructed evacuation pattern was found in 49 (38.5%) patients with Enterocele and in 148 (34.9%) patients in the control group. Conclusion Type C Enterocele is often associated with a radiological pattern of ODS and usually presents as an isolated condition. Type B is less frequently associated with ODS and is more frequently accompanied by other pathological conditions.
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Role of Enterocele in the obstructed defecation syndrome (ODS): a new radiological point of view
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2009Co-Authors: C Morandi, Jacopo Martellucci, P Talento, A CarrieroAbstract:Aim The aim of this study was to understand the role of Enterocele in the pathogenesis of the obstructed defecation syndrome (ODS) a new defecographic classification based on function. Method A total of 597 patients (551 women, 46 men) who underwent cinedefecography between November 2001 and November 2005 were studied. A total of 567 (95%) underwent cinedefecography as they had symptoms of ODS. Enterocele was classified into three types. Results Enterocele was found in 127 (23%) female and one (2.2%) male patients. Thirty-eight (6.9%) patients had type A, 38(6.9%) type B, and 27(4.9%) type C Enterocele. A total of 24 patients (4.35%) had sigmoidocele. In patients with type C Enterocele, the finding of a radiological pattern of ODS was higher (26/27) than that in the other groups (A + B + Sigmoidocele) (23/100) (P
Sven Petersen - One of the best experts on this subject based on the ideXlab platform.
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Stapled transanal rectal resection under laparoscopic surveillance for rectocele and concomitant Enterocele.
Diseases of the colon and rectum, 2006Co-Authors: Sven Petersen, Gunter Hellmich, A. Schuster, D. Lehmann, W. Albert, Klaus LudwigAbstract:Stapled transanal rectal resection recently became a recommended surgical procedure for obstructed defecation syndrome. One problem when using a transanal stapling device for rectal surgery is the potential threat to structures located in front of the anterior rectal wall. We decided to perform a combined procedure of transanal rectal resection with a simultaneous laparoscopy for patients with obstructed defecation syndrome and an Enterocele. Between November 2002 and May 2005 a total of 41 patients were treated surgically for obstructed defecation syndrome. Four patients with concomitant Enterocele underwent stapled transanal rectal resection under laparoscopic surveillance. Before surgery all patients underwent preoperative assessment, including clinical examination, colonoscopy, conventional video defecography, dynamic magnetic resonance imaging defecography, gynecology examinations, and psychologic evaluation. The mean operative time was 50 (±16.5) minutes for the conventional stapled transanal rectal resection and 67 (±14.1) minutes for combined laparoscopy and stapled transanal rectal resection (P < 0.01). Three major complications were observed: two had bleeding in the staple line (one from each group) and one had a late abscess in the staple line. The combination of the stapled transanal rectal resection procedure and laparoscopy provides the opportunity to perform transanal rectal resection without the threat of intra-abdominal lesions caused by Enterocele.
Mark D. Walters - One of the best experts on this subject based on the ideXlab platform.
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Anterior Enterocele: a report of three cases.
International urogynecology journal and pelvic floor dysfunction, 2004Co-Authors: Paul K. Tulikangas, James Chivian Lukban, Mark D. WaltersAbstract:Anterior Enterocele is an uncommon finding in patients with pelvic organ prolapse. We reviewed 490 consecutive operations for pelvic organ prolapse . Three anterior Enteroceles were identified in a series of 193 Enterocele repairs (1.6%). The presentation and treatment of each of these patients is reviewed.
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Enterocele: is there a histologic defect?
Obstetrics and gynecology, 2001Co-Authors: Paul K. Tulikangas, Mark D. Walters, Jennifer Brainard, Anne M. WeberAbstract:Abstract OBJECTIVE: To examine the histology of the vaginal wall in women with an Enterocele confirmed by physical examination, cystoproctography, and intraoperative exploration. METHODS: Thirteen women with posthysterectomy apical and posterior wall prolapse were evaluated with a detailed physical examination, cystoproctography, and intraoperative exploration. All women had Enterocele repair. A specimen of full thickness vaginal wall from the leading edge of the Enterocele was excised and examined histologically. The histology of these patients was compared with the histology of two comparison groups, five women undergoing hysterectomy without prolapse and 13 women undergoing radical hysterectomy. RESULTS: One woman with an Enterocele repaired intraoperatively did not have an Enterocele by cystoproctography. One woman with an Enterocele repaired intraoperatively did not have an Enterocele detected by physical examination. All women with an Enterocele repaired had an intact vaginal wall muscularis. No woman had vaginal wall epithelium in direct contact with the peritoneum. The average vaginal wall muscularis thickness in women with Enteroceles was 3.5 ± 1.4 mm, in women with no prolapse 3.2 ± 0.8 mm, and in women undergoing radical hysterectomy 2.8 ± 0.9 mm. CONCLUSION: Women with Enteroceles have a well-defined vaginal muscularis between the peritoneum and vaginal epithelium.
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Laparoscopic surgery for Enterocele, vaginal apex prolapse and rectocele.
International urogynecology journal and pelvic floor dysfunction, 1999Co-Authors: Marie Fidela R Paraiso, Tommaso Falcone, Mark D. WaltersAbstract:Laparoscopy has been applied to all aspects of gynecologic surgery, but few investigators have reported the repair of vaginal apex prolapse, Enterocele and rectocele via the laparoscopic route. This article reviews the indications, anatomy, operative technique, clinical results and complications of laparoscopic culdeplasty, Enterocele repair, posterior repair, sacral colpopexy and vaginal vault–uterosacral ligament suspension.
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Vaginal Enterocele Repair
Pelvic Floor Dysfunction, 1Co-Authors: Andrew I. Sokol, Mark D. WaltersAbstract:Multiple modalities of Enterocele repair are available depending on the anatomy, skill and preference of the surgeon, and need for additional abdominal or vaginal procedures. We have described our techniques for vaginal Enterocele repair. Isolation and closure of the Enterocele sac, along with proper repair of all of the prolapsed segments of the vagina, will result in optimal surgical results for the patient. Routine use of McCall culdoplasty after every hysterectomy would probably decrease the rate of iatrogenic Enterocele and vaginal apex prolapse.