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The Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of obstructed and ineffective defecation syndrome
Adolfo Renzi, Luigi Brusciano, Pasquale Talento, Luigi Marano, Francesca Iacobellis, Antonio Vallo, G. Frezza, Maurizio Grillo, Alessio Palumbo, Elisa Palladino, Benedetto Neola, Fabrizio Foroni, Michele Lanza, Massimo Antropoli, Carmine Antropoli, Mauro Maglio, Maria Laura Sandoval Sotelo, G Pagano, Maria Michela Di Nuzzo, L Vicenzo, Michele Schiano di Visconte, Gabriele Naldini, Leonardo Lenisa, Marcello Gasparrini, Giuseppe Candilio, Massimo Pezzatini, Francesca Ascari, Alberto Di Leo, Monica Urbani, Simona Ascanelli, Alessandro Bussotti, Natale Calomino, Domenico Izzo, Roberto Peltrini, Michele D’Ambra, Giovanni Greco, Giuseppe D’Oriano, Alfredo Giordano, Claudio Gambardella, Diletta Paola Iovino, Andrea Grego, Luigi Pellecchia, Luigi Monaco, Ilaria Ferrante, G Lamanna, Vinicio Mosca, Sergii Girnyi, Gianluca Minieri, L. Losacco, Giacomo Sarzo, Giuseppe Calabrò, Francesco Ghiglione, Sergio Agradi, Michele Pinto, A. Marazzi, Mariangela Desantis, Federico Maria Mongardini, M Mongardini, Aurora Marotta, Andrea Lauretta, Giovanni Ferreri, Alfredo Annicchiarico, Francesca Da Pozzo, Alfredo Ansalone, Matteo Zuin, Nadine Osman, Paolino Mauro, Corrado Rispoli, Tomasz Cwalinski, Roberto Rizzato, Nando Gallese, Marta Mozzon, Alessandro Stazi, Luana Franceschilli, Angelo Stuto, E Cudazzo, Silvia Malerba, Riccardo Brachet Contul, Antonio Canero, Nicola Antonacci, F. Milazzo, Costantino Magnani, Cristina Folliero, Francesca Babic, Silvia Marola, Andrea Braini, Guido Benegiamo, Umberto Cocozza, Bruno Masci, Rita Laforgia, Angela Pezzolla, Antonio Colangelo, Carmelo Geremia, Raffaella Marina Di Renzo, Claudio Eduardo Fernando Antonio Pagano, Roberto Picheo, U. Favetta, Fabrizio Gambarini, Laura Chimisso, Gianmattia Terracciano, Adelaide Andriani, Giovanni Marino, Patrizia Liguori, Carmen Formisano, Izabela Zofia Paszkiewicz, Alfonso Reginelli, Francesco Tumminelli, Martina Caruso, Marianna PENNACCHIO, Francesco Antonio Ciarleglio, Nicola Lizza, Francesco D’Aniello, Lorenzo Asciore, Pierluigi Bianchi, Emanuela Tessari, Eleonora Rossin, Maria Paola Menna, Giampiero Ucchino, Fabrizio Vittadello, Monica Oliva, Francesca Gatto, Raffaella Ferrando, Ilaria Granese, Mario Cicconi, Massimiliano Mistrangelo, Giovanna Ioia, Valeria Gianfreda, Ettore Greco, Adriana Maria Landolfi, Giandomenico Di Sarno, Vincenzo Landolfi, Carolina Bartolini, Luciano Onofrio, Domenico de Vito, Salvatore Napolitano, Vincenzo Bottino, Antonio Longo, Antonio Brescia, Chiara Casiraghi, Alfonso Alderisio, Mario Massimo Mensorio, Ludovico Docimo, Antonio Brillantino
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Résumé fourni par la source
The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) on the diagnosis and management of obstructed defecation syndrome (ODS), with the purpose of guiding physicians in the selection of the most appropriate treatment option. A panel of experts was appointed by the Board of the SIUCP to develop key questions addressing the main topics related to the management of ODS and to perform an accurate literature search for each topic, in order to provide evidence-based answers and to summarize them in structured statements. All clinical questions were discussed by the expert panel over multiple rounds using the Delphi approach, and consensus among the experts was achieved for each statement. The questions were formulated according to PICO (patients, intervention, comparison, outcome) criteria, and the statements were developed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In patients with ODS refractory to first-line medical therapy, rehabilitation may be considered as a therapeutic option, particularly in cases of dyssynergic defecation, whereas a surgical approach may be indicated in patients with a high symptom score and an Oxford prolapse grade system score ≥3 on defecography (using magnetic resonance imaging or another modality). Surgical options include stapled transanal rectal resection and ventral mesh rectopexy, eventually combined, respectively, with pelvic organ prolapse suspension and sacrocolpopexy in the presence of multicompartment pelvic prolapse. A transverse perineal support procedure may be considered in the presence of excessive perineal descent. In patients with recurrent symptoms after surgery, transanal irrigation may represent a useful therapeutic option.
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