Chapter-09 Recent Advances in Surgery of Pelvic Floor Disorders

BOOK TITLE: Recent Advances in Surgery 33

1. Pilkington Sophie A
2. Nugent Karen P
Publishing Year
Author Affiliations
1. University Surgical Unit, School of Medicine, Southampton General Hospital, Mailpoint 816, South Academic Block, Tremona Road, Southampton SO16 6YD, UK
2. University Surgical Unit, School of Medicine, Southampton General Hospital, Mailpoint 816, South Academic Block, Tremona Road Southampton SO16 6YD, UK
Chapter keywords


Pelvic floor disorders are a complex group of common conditions. One in nine women will undergo surgery for pelvic floor disorders during their lifetime. Of those who do undergo surgery, 30% will have additional surgery for the same condition. Unlike other branches of colorectal surgery, such as colorectal cancer and inflammatory bowel disease, there is no histological gold standard for diagnosis. Research into the underlying etiology of pelvic floor disorders has focused on collagen abnormalities, but there is no unifying tissue diagnosis. Patients present with symptoms of anal incontinence, defecatory disorders, prolapse (mucosa, hemorrhoids, internal and external rectum, posterior vaginal wall (rectocele) and pelvic organ prolapse), pelvic pain and general dissatisfaction with their bowels (symptoms, such as bleeding, itching, urge fecal incontinence, passive fecal incontinence, post-defecatory leak and constipation). In the diagnosis of pelvic floor disorders it is important to exclude colorectal cancer. Pelvic floor MDT discussion of complex patients enables the establishment of a definitive management plan and is an integral component of a comprehensive pelvic floor service. Symptom severity and quality of life questionnaires are a useful supplement to a thorough history for the assessment of patients with pelvic floor disorders. Complete pelvic floor ultrasound is a valuable addition to the physical examination in patients with pelvic floor disorders and includes three dimensional and dynamic ultrasound. Conservative management with manipulation of stool consistency, BFB and/or rectal irrigation is usually the first line of treatment. Selected patients with obstructive defecation symptoms and evidence of rectal intussusception are offered surgery in the form of laparoscopic ventral rectopexy or STARR. The STARR procedure involves the use of an endoanal stapling device to resect and anastomose full thickness rectum, thereby removing redundant rectum associated with rectal intussusception and rectocele.

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