OBJECTIVES: To investigate the characteristics and clinical significance of anorectal manometry measurements in children with tethered cord syndrome (TCS) before and after surgery. METHODS: A retrospective study was conducted on 44 children with TCS treated at the Children's Hospital of Zhejiang University School of Medicine from January 2022 to September 2023. These patients were divided into effective subgroup (n=34) and non-effective subgroup (n=10) based on postoperative symptom improvement. Additionally, 34 children with functional constipation were selected as a control group. Baseline data and manometry measurements were compared between the preoperative TCS group and the control group, as well as between the non-effective and effective subgroups. RESULTS: The TCS group had lower short contraction time and defecation relaxation rate compared to the control group (P<0.05), while defecation residual pressure and maximum rectal tolerable threshold were higher than the control group (P<0.05). The length of the anal canal in the high-pressure zone in the effective subgroup was greater postoperatively than preoperatively (P<0.05), and the initial rectal sensation threshold decreased postoperatively (P<0.05). The non-effective subgroup had lower preoperative maximum rectal expulsion pressure compared to the effective subgroup (P<0.05). Postoperative rectal anal inhibition reflex values in the effective subgroup were higher than those in the non-effective subgroup (P<0.05). CONCLUSIONS There are some differences in anorectal dynamics between children with TCS and those with functional constipation. Maximum rectal expulsion pressure may be a key predictor of surgical outcomes. Surgery can alter certain defecation functions in some children.
Humans ; Male ; Anal Canal/physiopathology* ; Female ; Rectum/physiopathology* ; Child ; Child, Preschool ; Retrospective Studies ; Manometry ; Neural Tube Defects/physiopathology* ; Infant ; Defecation ; Adolescent ; Constipation/physiopathology* ; Clinical Relevance

OBJECTIVE: To evaluate the efficacy and safety of Wuda Granule (WDG) on recovery of gastrointestinal function after laparoscopic bowel resection in the setting of enhanced recovery after surgery (ERAS)-based perioperative care. METHODS: A total of 108 patients aged 18 years or older undergoing laparoscopic bowel resection with a surgical duration of 2 to 4.5 h were randomly assigned (1:1) to receive either WDG or placebo (10 g/bag) twice a day from postoperative days 1-3, combining with ERAS-based perioperative care. The primary outcome was time to first defecation. Secondary outcomes were time to first flatus, time to first tolerance of liquid or semi-liquid food, gastrointestinal-related symptoms and length of stay. Subgroup analysis of the primary outcome according to sex, age, tumor site, surgical time, histories of underlying disease or history of abdominal surgery was undertaken. Adverse events were observed and recorded. RESULTS: A total of 107 patients [53 in the WDG group and 54 in the placebo group; 61.7 ± 12.1 years; 50 males (46.7%)] were included in the intention-to-treat analysis. The patients in the WDG group had a significantly shorter time to first defecation and flatus [between-group difference -11.01 h (95% CI -20.75 to -1.28 h), P=0.012 for defecation; -5.41 h (-11.10 to 0.27 h), P=0.040 for flatus] than the placebo group. Moreover, the extent of improvement in postoperative gastrointestinal-related symptoms in the WDG group was significantly better than that in the placebo group (P<0.05). Subgroup analyses revealed that the benefits of WDG were significantly superior in patients who were male, or under 60 years old, or surgical time less than 3 h, or having no history of basic disease or no history of abdominal surgery. There were no serious adverse events. CONCLUSION The addition of WDG to an ERAS postoperative care may be a viable strategy to enhance gastrointestinal function recovery after laparoscopic bowel resection surgery. (Registry No. ChiCTR2100046242).
Humans ; Laparoscopy/adverse effects* ; Male ; Female ; Middle Aged ; Double-Blind Method ; Recovery of Function ; Drugs, Chinese Herbal/adverse effects* ; Treatment Outcome ; Gastrointestinal Tract/physiopathology* ; Defecation ; Aged ; Intestines/physiopathology*

Advances in surgical techniques and treatment concept have allowed more patients with low rectal cancer to preserve sphincter without sacrificing survival benefit. However, postoperative dysfunctions such as fecal incontinence, frequency, urgency, and clustering often occur in patients with low rectal cancer. The main surgical procedures for low rectal cancer include low anterior rectum resection (LAR), intersphincteric resection (ISR), coloanal anastomosis (Parks) and so on. The incidence of major LARS after LAR is up to 84.6%. The postoperative function of ISR is even worse than LAR. Moreover, the greater the extent of resection ISR surgery, the worse the postoperative function. There are few studies on the function of Parks procedure. Current evidence suggests that the short-term function of Parks procedure is inferior to LAR, but function can gradually recovered over time. Colorectal surgeons have attempted to improve postoperative defecation by modifying bowel reconstructions. Current evidence suggests that J pouch or end-to-side anastomosis during LAR does not reduce the incidence of defecation disorders. Pouch reconstruction during ISR cannot reduce the incidence of severe LARS either. In general, the protection of postoperative defecation function in patients with low rectal cancer still has a long way to go.
Anal Canal/surgery* ; Anastomosis, Surgical/adverse effects* ; Defecation ; Fecal Incontinence/etiology* ; Humans ; Postoperative Complications/epidemiology* ; Rectal Neoplasms/surgery*

Objective: To understand the current status of diagnosis and treatment regarding the protection of defecation function in Chinese surgeons performing sphincter-preserving resections (SPR) for rectal cancer in order to discover the problems existing in the function protection during SPR and provide support and reference for the standardized clinical management of rectal cancer. Methods: A cross-sectional survey was performed. Colorectal surgeons who obtained the medical qualifications and volunteered to participate in this study were included, and respondents with incomplete information were excluded. From October 18 to 22, 2020, randomized sampling was conducted among Chinese colorectal surgeons from Chinese Association of Colorectal Surgeons, Chinese Colorectal Cancer Committee, Chinese Sexology Association Anal functional Surgery Committee and National Health Commission Capacity Building and Continuing Education Committee. The questionnaire included basic information of the respondents, assessment of defecation function before SPR, intraoperative details, postoperative follow-up, evaluation and intervention of patients with low anterior resection syndrome (LARS). Observation indicator: results of the questionnaire survey. Result: A total of 231 questionnaires were collected, and 230 were effective, with an effective rate of 99.6%. Among these participants, 217 (94.3%) were males; 107 (46.5%) had medical doctor degrees; 129 (56.1%) were national commission members in colorectal surgery; 137 (59.6%) performed more than 50 SPR operations per year; 211 (91.7%) assessed defection function by auxiliary examinations before SPR. Rigid sigmoidoscopy (n=116, 55.0%) and anorectal manometer (n=81, 38.4%) were the most commonly used method. Among the 230 respondents, 64.8% (n=149) of surgeons used 2D laparoscopy for SPR surgery most commonly, and 51.3% (n=118) of surgeons performed direct colorectal anastomosis for reconstruction, and 98.3% (n=226) used staplers during anastomosis. All the surgeons indicated that they would follow up patients after SPR, and outpatient clinic was the most common method (84.4%, 184/230). When LARS occurred, 50.0% (115/230) of surgeons chose defecation function scale and 78.7% (181/230) actively provided guidance and intervention for patients. Conclusions: Chinese colorectal surgeons still have shortcomings in the protection of defecation function during SPR for rectal cancer. They do not make enough preoperative functional evaluation and postoperative functional recovery estimate for patients. The knowledge and use of defecation function scales and interventions on LARS are expected to be standardized.
Anal Canal/surgery* ; China ; Cross-Sectional Studies ; Defecation ; Humans ; Male ; Postoperative Complications/prevention & control* ; Rectal Neoplasms/surgery* ; Surgeons ; Surveys and Questionnaires ; Syndrome

Introduction: Yakult contains Lactobacillus casei strain Shirota (LcS). It has several protective effects on our digestive system which include preventing diarrhoea and improving constipation. The objective of our study was to determine the effect of a single dose of Yakult on whole gut transit time (WGTT) among young adults. Methods: A cross-sectional study of 73 students who did not have any gastrointestinal disorder was performed. Subjects were given 4 carbon pills as a visual indicator to measure their WGTT in the normal setting of their usual activities. They then repeated measurement while consuming one dose of commercially available Yakult and 4 carbon pills (visual indicator). In the 2 settings, subjects were instructed to consume carbon pills and carbon pills with Yakult within 1 hour after bowel motion. Results: The WGTT decreased in 48 of the 73 subjects (65.8%) after consuming Yakult. The mean WGTT was reduced by 4.4±14.6 hours. There was no significant effect of Yakult on the form of stools. Conclusion Yakult which contains Lactobacillus casei strain Shirota (LcS) is well known for helping in digestion and preventing constipation. A single dose of Yakult produces a reduction in the WGTT.
Defecation ; Constipation

The significant increase in the incidence of benign anal diseases is related to the fast-paced life style, the change of dietary structure, the increase of work pressure and social psychological factors. Surgery is one of the most important treatments for benign anal diseases, while perioperative defecation management is closely related to the efficacy of surgery. In current clinical practice, there is no consensus on the management of perioperative defecation for benign anal diseases. Hence a discussion was held by the Professional Committee of Colorectal Diseases of Chinese Society of Integrated Chinese and Western Medicine, concerning the causes of perioperative defecation difficulties in perioperative anal benign diseases, the importance and specific strategy of defecation management. A consensus was consequently formed, aiming to provide a guideline for the clinical practice.
Anal Canal/surgery* ; Anus Diseases/surgery* ; China ; Consensus ; Defecation ; Humans ; Perioperative Care ; Perioperative Period

Child ; Colon ; Constipation ; Defecation ; Fecal Incontinence ; Humans ; Male ; Polyethylene Glycols ; Retrospective Studies ; Soil

OBJECTIVE: To compare the effects of transanal total mesorectal excision (taTME) and laparoscopic total mesorectal excision (laparoscopic TME) on patients' postoperative long-term bowel function. METHODS: A retrospective cohort study was used in this study. We analyzed the clinical data of 134 patients with locally advanced mid-low rectal cancer, who underwent transanal TME or laparoscopic TME in the TaLaR randomized controlled trial at the Sixth Affiliated Hospital, Sun Yat-sen University from April 2016 to November 2017. Inclusion criteria included age of 18 to 80 years old, distance from tumor low margin to anal edge ≤10 cm, preoperative staging of T1-3NxM0, and single rectal adenocarcinoma. Exclusion criteria included local recurrence, distant metastases, abdominoperineal resection, unreduced stoma, new stoma, less than 1 year after protectomy or stoma reduction, or preoperative poor anal function or incontinence. Patients were divided into taTME group and laparoscopic TME group. The taTME group received hybrid transanal and transabdominal approach performed simultaneously. The effects of surgical procedures on postoperative bowel function were evaluated with LARS (low anterior resection syndrome) scale, where 0-20 was defined as " no LARS" , 21-29 as " minor LARS" , and 30-42 as " major LARS" . Univariate and multivariate logistic regression analyses were performed to determine the risk factors associated with major LARS, with surgical approach as a pre-selected variate. RESULTS: A total of 107 patients were included. Of the 54 patients in the taTME group, 35 were male, median age was 57.2 (26.0-77.0) years old, and 22 cases had a tumor less than 5 cm from anal verge. Of the 53 patients in the laparoscopic TME group, 35 were male, median age was 62.0 (33.0-73.0) years old, and 25 cases had a tumor less than 5 cm from anal verge. All baseline clinical data including age, gender, preoperative staging, and tumor height were comparable between the two groups (all P>0.05). All operations in both groups were performed successfully. The operation time, intra-operative blood loss, postoperative anastomotic complication, postoperative hospital stay were comparable between the two groups (all P>0.05), except for a lower diverting stoma rate in the taTME group [37.0% (20/54) vs. 64.2% (34/53), χ²=7.866, P=0.005]. Of the 107 patients, 27 (25.2%) had no LARS, 32 (29.9%) had minor LARS, and 48 (44.9%) had major LARS, after a median follow-up of 17.2 (12.1-30.4) months. No significant difference was found between the two groups in overall bowel function [major LARS: 48.1% (26/54) vs. 41.5% (22/53), Z=-0.994, P=0.320]. Compared with the laparoscopic TME group, the taTME group experienced worse clustering of stools [68.5% (37/54) vs. 45.3% (24/53), Z=-2.354, P=0.019]. However, there were no significant differences between the two groups in terms of gas incontinence, liquid stool incontinence, frequency of defecation, and urgency (all P>0.05). Multivariate analysis identified preoperative radiotherapy (OR=5.073, 95% CI: 1.336 to 19.259, P=0.017) and anastomotic height (OR=3.633, 95% CI: 1.501 to 8.802, P=0.004) as independent risk factors for major LARS, but no impact of taTME on LARS (OR=1.442, 95% CI: 0.638 to 3.261, P=0.379). CONCLUSIONS Compared with laparoscopic TME, taTME has similar outcomes of postoperative long-term bowel function. Preoperative radiotherapy and anastomotic height, but not surgical approach, are independent risk factors for postoperative bowel function.
Adult ; Aged ; Defecation ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Postoperative Complications ; Rectal Neoplasms ; surgery ; Rectum ; Retrospective Studies ; Syndrome ; Transanal Endoscopic Surgery ; Young Adult

PURPOSE: Nonsurgical treatment of hemorrhoidal disease (HD) includes medical and instrumental techniques. We aimed to compare the efficacy of the most frequently used nonsurgical strategies, either alone or in combination, applied in an ambulatory setting.METHODS: Patients who received nonsurgical treatment for HD by proctology appointment at the Gastroenterology Department of Braga Hospital were evaluated. Isolated rubber band ligation (RBL) and a combination of RBL with a micronized purified flavonoid fraction (MPFF) were the 2 most frequently used strategies. Symptoms of HD (bleeding, pruritus, pain at rest, pain at defecation and prolapse) were assessed at days 0, 7, and 28 by using a severity grading scale (0 to 4/5). A Global Symptom score was constructed to assess the overall severity and compare the overall improvements of the HD symptoms between the 2 most frequently used strategies.RESULTS: Nineteen patients underwent the combined treatment (RBL + MPFF group) and 25 the RBL treatment (RBL group). A comparison of the 2 treatment groups showed significant improvements in the combined treatment group in terms of bleeding at days 7 (P = 0.001) and 28 (P = 0.002) and in the pruritus intensity during the first week (P < 0.001). A trend toward clinical benefit was also verified in the combined treatment group for all other HD symptoms (pain at rest, pain at defecation and prolapse).CONCLUSION: A combined treatment approach with MPFF and RBL significantly reduced the intensity of bleeding during the first month and the pruritus during the first week.
Cohort Studies ; Colorectal Surgery ; Defecation ; Flavonoids ; Gastroenterology ; Hemorrhage ; Hemorrhoids ; Humans ; Ligation ; Pruritus ; Rubber

PURPOSE: To compare the effectiveness of the magnesium (Mg)-enriched formula vs. control formula in constipated infants. METHODS: An open-label, interventional, and the comparator-controlled study was conducted to evaluate the effectiveness of the Mg-enriched formula in formula-fed infants ≤6 months old presenting with functional constipation according to modified Rome IV criteria. Infants were randomized 1:1 to intervention or control formula for 30 days. Parents recorded stool consistency (hard, normal, or watery) and frequency on days 1–7 and 23–29. Physicians recorded patient baseline characteristics and performed the clinical examination at the time of three patient visits (baseline, day 8, and 30). RESULTS: Of the 286 recruited infants, 143 received the Mg-rich formula and 142 received the control formula. After 7 days, significantly more infants had stools with normal consistency with the Mg-rich formula compared to the infants fed with the control formula (81.8% vs. 41.1%; p<0.001). The number of infants passing one or more stools per day was increased at day 7 in the Mg-rich formula group (86.7% vs. 68.2%; p<0.001). At days 7 and 29, >25% of infants responded completely to the Mg-rich formula compared to <5% of infants fed with the control formula (p<0.001). Parents of infants in the Mg-rich formula group were very satisfied with the treatment (80.8% vs. 10.2%), with the majority willing to continue treatment after 30 days (97.9% vs. 52.6%; p<0.001). CONCLUSION: The Mg-rich formula significantly improved stool consistency and frequency compared to the control formula in constipated infants.
Constipation ; Defecation ; Humans ; Infant Formula ; Infant ; Magnesium ; Nutrition Therapy ; Parents