Recto-sigmoid junction pressure variations in patients with symptomatic obstructed defecation syndrome and the approach to management

Abstract

Abstract Purpose Are clinical and manometric results sufficient to plan management in patients with obstructed defecation syndrome (ODS)? This paper assesses the variations in rectosigmoid junction (RSJ) pressure together with the anal and rectal pressures in ODS in relation to clinical symptoms. Management plans are then suggested for specific cases based on the manometric and clinical results and the success of such plans are measured and may be an economical and convenient alternative to more advanced techniques. Methods A case-control study including 60 patients, 30 cases & 30 control, clinically shown to have ODS, who underwent assessment of the RSJ pressure using anorectal manometry. The results and variations are recorded, and management suggested based upon the manometric results. Results High RSJ pressure in 30 cases revealed a statistically significant positive correlation with the severity of symptoms, according to Cleveland clinic constipation score, when compared to controls. However, long term follow-up of management, based on the manometric & clinical results, showed a high degree of recurrence. Conclusion High pressure in the RSJ is directly correlated to the severity ODS, eliminating this high-pressure zone via sigmoidectomy can lead to improvement of symptoms in the short-term, however, management should not be planned solely on manometry and clinical symptomatology as recurrence rates are high in the long-term. Rather, manometry should be supplementary to planing surgical management with other more advanced techniques, such as MRI defectography.