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Improved Outcomes in Colon and Rectal Surgery part 39

Improved Outcomes in Colon and Rectal Surgery part 39. Written by many of the worlds leading colorectal surgeons, this evidence-based text investigates the risks and benefits of colorectal surgeries. By using clinical pathways, algorithms, and case discussions, the authors identify the best practices for patient safety and positive outcomes to ensure that physicians correctly recognize potential problems and carefully manage complications | improved outcomes in colon and rectal surgery determine which method is superior a recent meta-analysis of the available literature was used to compare the treatment outcome using EMG vs. pressure biofeedback. 87 EMG biofeedback was primarily used in 18 studies 442 subjects with a mean success rate improved symptoms of 70 . Pressure biofeedback training was used in 13 studies 275 subjects with a mean success rate of 78 . These results showed a significantly better outcome in patients with pressure biofeedback protocols. Further analysis compared intraanal to perianal EMG biofeedback and their results showed no significant difference between the two subgroups 69 vs. 72 respectively . Overall these data show success rates ranging from 69 to 78 regardless of which protocol or what instrumentation is used however without controlled trials the optimal protocol for subjects with dyssynergic-type constipation remains unclear. The role of other factors on the outcome of biofeedback therapy in patients with pelvic dyssynergy has been studied. In one study the only predictor of successful outcome was the number of sessions attended 5 or more and whether the therapist discharged the patient 63 success rate rather than the patient terminating treatment prematurely 25 success rate . 90 To date researchers have not been able to identify any physiologic manometry and balloon expulsion test anatomic rectocele intussusception or abnormal perineal descent or demographic age gender duration of symptoms variables that influence treatment outcome however many investigators do suggest that psychopathology may influence biofeedback treatment outcome. Anxiety and psychological distress are commonly associated with pelvic floor dyssynergy. One study showed that patients with pelvic floor dys-synergic-type constipation or rectal pain showed a tendency to use somatization as a defense mechanism to manage psychological distress. 91 This pattern was not seen in a comparison group of patients .