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European Journal of Oncology Nursing :... Oct 2021After the reversal of the temporary stoma, rectal cancer survivors are often confronted with bowel complaints largely impacting on their quality of life. This systematic... (Review)
Review
PURPOSE
After the reversal of the temporary stoma, rectal cancer survivors are often confronted with bowel complaints largely impacting on their quality of life. This systematic review aims to identify and synthesise the experiences and needs of patients with rectal cancer confronted with bowel problems after stoma reversal.
METHODS
A systematic search was performed through Pubmed, CINAHL and Web of Science. Only studies with a qualitative design were included in this review. Quality assessment was done by the critical appraisal skill programme (CASP) Qualitative Studies Checklist. A thematic-synthesis was performed.
RESULTS
Of 2713 identified papers, 10 were included in this systematic review. Two general themes were identified: 'experiences and needs about bowel function before surgery' and 'experiences and needs afterwards'. Before restoration of continuity patients had to cope with the temporary stoma, and they felt uncertain about what to expect. Patients indicated that the timing of providing information was crucial but varied. Bowel problems after surgery had a physical and emotional impact on patients' family life. They were also confronted with shame and stigma. Patients were happy to be alive and cancer free but were hopeful that the bowel problems would resolve. They used several strategies to manage and cope with these symptoms. Peers and healthcare professionals proved valuable resources of support.
CONCLUSION
Rectal cancer survivors experience ongoing bowel problems after treatment. Patients describe experiences and needs before rectal cancer surgery and afterwards when confronting with bowel problems. Follow-up care should be organised proactively and focus on management strategies and emotional support.
Topics: Adaptation, Psychological; Defecation; Humans; Quality of Life; Rectal Neoplasms; Surgical Stomas
PubMed: 34543812
DOI: 10.1016/j.ejon.2021.102018 -
International Urogynecology Journal Sep 2019Several posterior compartment surgical approaches are used to address posterior vaginal wall prolapse and obstructed defecation. We aimed to compare outcomes for both...
INTRODUCTION AND HYPOTHESIS
Several posterior compartment surgical approaches are used to address posterior vaginal wall prolapse and obstructed defecation. We aimed to compare outcomes for both conditions among different surgical approaches.
METHODS
A systematic review was performed comparing the impact of surgical interventions in the posterior compartment on prolapse and defecatory symptoms. MEDLINE, Embase, and ClinicalTrials.gov were searched from inception to 4 April 2018. Randomized controlled trials, prospective and retrospective comparative and single-group studies of women undergoing posterior vaginal compartment surgery for vaginal bulge or bowel symptoms were included. Studies had to include both anatomical and symptom outcomes both pre- and post-surgery.
RESULTS
Forty-six eligible studies reported on six surgery types. Prolapse and defecatory symptoms improved with native-tissue transvaginal rectocele repair, transanal rectocele repair, and stapled transanal rectocele repair (STARR) surgeries. Although prolapse was improved with sacrocolpoperineopexy, defecatory symptoms worsened. STARR caused high rates of fecal urgency postoperatively, but this symptom typically resolved with time. Site-specific posterior repairs improved prolapse stage and symptoms of obstructed defecation. Compared with the transanal route, native-tissue transvaginal repair resulted in greater improvement in anatomical outcomes, improved obstructed defecation symptoms, and lower chances of rectal injury, but higher rates of dyspareunia.
CONCLUSIONS
Surgery in the posterior vaginal compartment typically has a high rate of success for anatomical outcomes, obstructed defecation, and bulge symptoms, although these may not persist over time. Based on this evidence, to improve anatomical and symptomatic outcomes, a native-tissue transvaginal rectocele repair should be preferentially performed.
Topics: Constipation; Female; Gynecologic Surgical Procedures; Humans; Pelvic Organ Prolapse; Practice Guidelines as Topic; Prospective Studies; Randomized Controlled Trials as Topic; Rectocele; Retrospective Studies; Transanal Endoscopic Surgery; Vagina
PubMed: 31256222
DOI: 10.1007/s00192-019-04001-z -
Colorectal Disease : the Official... Sep 2017This manuscript provides the introduction and detailed methodology used in subsequent reviews to assess the outcomes of surgical interventions with the primary intent of... (Review)
Review
AIM
This manuscript provides the introduction and detailed methodology used in subsequent reviews to assess the outcomes of surgical interventions with the primary intent of treating chronic constipation in adults and to develop recommendations for practice.
METHOD
PRISMA guidance was adhered to throughout. A literature search was performed in public databases between January 1960 and February 2016. Studies that fulfilled strictly-defined PICOS (patients, interventions, controls, outcome, and study design) criteria were included. The process involved two groups of participants: (i): 'a clinical guidance group' of 18 UK experts (including junior support) who performed the systematic reviews and produced summary evidence statements (SES) based strictly on data synthesis in each review. The same group then produced prototype graded practice recommendations (GPRs) based on coalescence of SES and expert opinion; (ii): a European Consensus group of 18 ESCP (European Society of Coloproctology) nominated experts from nine European countries evaluated the appropriateness of each prototype GPR based on published RAND/UCLA methodology.
RESULTS
An overview of the search results is provided in this manuscript. A total of 156 studies from 307 full text articles (from 2551 initially screened records) were included, providing data on procedures characterized by: (i) colonic resection (n = 40); (ii) rectal suspension (n = 18); (iii) rectal wall excision (n = 44); (iv) rectovaginal septum reinforcement (n = 47); (v) sacral nerve stimulation (n = 7). The overall quality of evidence was poor with 113/156 (72.4%) studies providing only Oxford level IV evidence. The best evidence was extracted for rectal excisional procedures, where the majority of studies were Oxford level I or II. The five subsequent reviews provide a total of 99 SES (reflecting perioperative variables, efficacy, harms and prognostic variables) that contributed to 100 prototype GPRs covering patient selection, procedural considerations and patient counselling. The final manuscript details the 85/100 GPRs that were deemed appropriate by European Consensus (remaining 15 were all uncertain) and future research recommendations.
CONCLUSION
This manuscript and the following 6 papers suggest that the evidence base for surgical management of chronic constipation is currently poor although some expert consensus exists on best practice. Further studies are required to inform future commissioning of treatments and of research funding.
Topics: Bias; Chronic Disease; Constipation; Evidence-Based Medicine; Humans; Research Design; Review Literature as Topic
PubMed: 28960925
DOI: 10.1111/codi.13774 -
Acupuncture in Medicine : Journal of... Oct 2017To assess the effectiveness of electroacupuncture (EA) relative to conventional medication in functional constipation (FC). (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVES
To assess the effectiveness of electroacupuncture (EA) relative to conventional medication in functional constipation (FC).
DESIGN
Systematic review and meta-analysis.
SETTING
To be included, studies needed to: (1) have been randomised controlled trials; (2) have recruited adult patients diagnosed with FC according to the Rome II/III criteria or the American Gastroenterological Association guideline for chronic FC; and (3) have randomised patients to be treated with EA or anti-constipation medication. We searched Medline, the Cochrane Library and Embase databases for articles published up to 30 June 2016.
INTERVENTION
EA or anti-constipation medication.
PRIMARY AND SECONDARY OUTCOME MEASURES
The primary outcome was the change in the number of weekly spontaneous bowel movements. Secondary outcomes were total response rate (or total effective rate), symptom reduction and Cleveland Clinic constipation scores.
RESULTS
The pooled results showed significantly more improvement in the frequency of spontaneous bowel movements in the EA treatment group compared with the medicine-treated group (pooled SMD 0.244, 95% CI 0.065 to 0.424, P=0.008). Deep-needling EA was significantly more effective than treatment with medication at increasing the frequency of spontaneous bowel movements (p=0.019). Significantly greater improvement was also seen for total response rates (p=0.018) and reductions in symptom score (p<0.001) in EA-treated patients.
CONCLUSIONS
EA was more effective than medication at improving spontaneous bowel movements and total response rate, and reducing the symptoms of FC.
Topics: Adult; Aged; Constipation; Defecation; Electroacupuncture; Female; Humans; Laxatives; Male; Middle Aged; Treatment Outcome; Young Adult
PubMed: 28630049
DOI: 10.1136/acupmed-2016-011127 -
Journal of Laparoendoscopic & Advanced... Apr 2017To compare intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA) in laparoscopic right colectomy (LRC) in terms of intraoperative and postoperative... (Comparative Study)
Comparative Study Meta-Analysis Review
AIM
To compare intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA) in laparoscopic right colectomy (LRC) in terms of intraoperative and postoperative outcomes.
METHODS
A systematic literature search with no limits was performed in PubMed and Embase. The last search was performed on April 9, 2016. The outcomes of interests included intraoperative outcomes (operative time, blood loss, length of incision, conversion, lymph nodes harvested, and intraoperative complications) and postoperative outcomes (time to first flatus, time to first defecation, time to liquid diet, length of hospital stay, postoperative complications, mortality, ileus, anastomotic leakage, anastomotic bleeding, wound infection, hernia, and intra-abdominal abscess).
RESULTS
Fifteen articles and four conference abstracts published between 2004 and 2016 with a total of 1957 patients were enrolled in this meta-analysis. IA was associated with significant less blood loss, smaller length of incision, shorter time to first defecation, shorter time to liquid diet, and shorter length of hospital stay. No differences were found for operative time, conversion, lymph nodes harvested, intraoperative complications, time to first flatus, postoperative complications, mortality, anastomotic leakage, anastomotic bleeding, ileus, wound infection, intra-abdominal abscess, or hernia between IA and EA.
CONCLUSION
Our meta-analysis suggests that the IA for LRC improves cosmesis and results in better postoperative recovery outcomes without increasing intraoperative and postoperative complications. Furthermore, a large randomized control study is warranted to compare the short-term and long-term outcomes of those two anastomosis techniques.
Topics: Abdominal Abscess; Anastomosis, Surgical; Anastomotic Leak; Colectomy; Colon, Ascending; Humans; Ileus; Intraoperative Complications; Laparoscopy; Length of Stay; Lymph Node Excision; Lymph Nodes; Operative Time; Postoperative Complications; Postoperative Hemorrhage; Postoperative Period; Surgical Wound Infection; Treatment Outcome
PubMed: 27768552
DOI: 10.1089/lap.2016.0485 -
Infectious Diseases 2022A Soil-transmitted helminthic infection (STHIs) remains a notable health problem in resource-limited countries.
BACKGROUND
A Soil-transmitted helminthic infection (STHIs) remains a notable health problem in resource-limited countries.
OBJECTIVE
This systematic review and meta-analysis aimed to determine the overall prevalence of STH infections in Ethiopia.
METHODS
Articles written in English were searched from online public databases. Searching terms taken separately and jointly were "prevalence," "soil-transmitted helminths" "nematode," "Geo-helminths," "roundworm," "Necator," "Ancylostoma," "Ascaris," "Trichuris," "hookworm," "whipworm," "," "associated factors," and "Ethiopia." We used STATA version 14 for meta-analysis and Cochran's Q test statistics and the test for heterogeneity.
RESULT
From 297 reviewed articles 41 fulfilled the inclusion criteria. The pooled prevalence of STH infections in Ethiopia was 36.78% Ascaris lumbricoides had the highest pooled prevalence 17.63%, followed by hook worm12.35%. Trichuris trichiura 7.24% when the prevalence of was 2.16% (95% CI: 0.97-3.35). Age, sex, residence, family education level, lack of shoe wearing habits and open defecation were identified as risk factors for STH infection. Eating unwashed and uncooked fruit and vegetables increased the risk of STH infection by 1.88 times while untrimmed finger nail and lack of hand washing habits increase the risk of STH infection by 1.28 and 3.16 times respectively with 95% CI.
LIMITATION
Lack of published studies from Afar, Gambela, Somali, and Benshangul gumuz regions may affect the true picture. The other limitation is that the search strategy will be restricted articles published only in the English language but there might be articles that published using another language.
CONCLUSION
Ascaris lumbricoides, hookworms and Trichuris trichiura, are the most prevalent soil-transmitted helminthes infections in Ethiopia. Age, sex, residence, family education level, lack of shoe wearing habits Open defecation untrimmed finger nail and lack of hand washing habits significantly associated with STH infection. When eating unwashed, uncooked fruit and vegetables were not significantly associated with STH infection. Strategic use of anti-helminthic, health education, and adequate sanitation, taking into account this epidemiologic information is helpful in the control of STH infections in Ethiopia.
PubMed: 35356097
DOI: 10.1177/11786337211055437 -
Frontiers in Medicine 2023Postoperative ileus (POI) is one of the main complications after colorectal cancer (CRC) surgery, and there is still a lack of effective treatment. At present, the... (Review)
Review
BACKGROUND
Postoperative ileus (POI) is one of the main complications after colorectal cancer (CRC) surgery, and there is still a lack of effective treatment. At present, the evidence for improvement of POI by invasive acupuncture (manual acupuncture and electroacupuncture, IA) is limited. This meta-analysis of randomized controlled trials (RCTs) aims to systematically review and evaluate the effect of IA in improving POI after CRC surgery.
METHODS
This meta-analysis was reported according to PRISMA statement and AMSTAR guidelines. The retrieval time was from the inception to February 2023. The RCTs were screened by searching the databases (PubMed, Ovid, Embase, Cochrane Library, China National Knowledge Infrastructure, VIP Database, Sinomed Database, and WANFANG). Two independent investigators screened and extracted the data, assessed the risk of bias, and performed statistical analysis. The statistical analysis was carried out by RevMan5.3. The PROSPERO International Prospective Register of Systematic Reviews received this research for registration (CRD42023387700).
RESULTS
Thirteen studies with 795 patients were included. In the primary outcome indicators: the IA group had shorter time to the first flauts [stand mean difference (SMD), -0.57; 95% CI, -0.73 to -0.41, < 0.00001], shorter time to the first defecation [mean difference (MD), -4.92 h, 95% CI -8.10 to -1.74 h, = 0.002] than the blank/sham stimulation (B/S) group. In the secondary outcome indicators: the IA group had shorter time to the first bowel motion (MD, -6.62 h, 95% CI -8.73 to -4.50 h, < 0.00001), shorter length of hospital (SMD, -0.40, 95% CI -0.60 to -0.21, < 0.0001) than the B/S group. In terms of the subgroup analysis: IA associated with enhanced recovery after surgery (ERAS) group had shorter time to the first flauts (MD, -6.41 h, 95% CI -9.34 to -3.49 h, < 0.0001), shorter time to the first defacation (MD, -6.02 h, 95% CI -9.28 to -2.77 h, = 0.0003) than ERAS group.
CONCLUSION
Invasive acupuncture (IA) after CRC surgery, acupuncture or electricacupuncture with a fixed number of times and duration at therapeutic acupoints, can promote the recovery of POI. IA combined with ERAS is better than simple ERAS in improving POI.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=387700, identifier CRD42023387700.
PubMed: 37692781
DOI: 10.3389/fmed.2023.1201769 -
PloS One 2017This meta-analysis analyzed the efficacy and safety of traditional Chinese medicine (TCM) for the treatment of irritable bowel syndrome with constipation (IBS-C). (Meta-Analysis)
Meta-Analysis Review
AIM
This meta-analysis analyzed the efficacy and safety of traditional Chinese medicine (TCM) for the treatment of irritable bowel syndrome with constipation (IBS-C).
METHODS
We searched seven electronic databases for randomized controlled trials investigating the efficacy of TCM in the treatment of IBS-C. The search period was from inception to June 1, 2017. Eligible RCTs compared TCM with cisapride and mosapride. Article quality was evaluated with the Cochrane Risk Bias Tool in the Cochrane Handbook by two independent reviewers. Begg's test was performed to evaluate publication bias. Review Manager 5.3 and Stata 12.0 were used for analyses.
RESULTS
Eleven eligible studies comprising a total of 906 participants were identified. In the primary outcome, TCM showed significant improvement in overall clinical efficacy compared with cisapride and mosapride (odds ratio [OR] = 4.00; 95% confidence interval [CI]: 2.74,5.84; P < 0.00001). In terms of secondary outcomes, TCM significantly alleviated abdominal pain (OR = 5.69; 95% CI: 2.35, 13.78; P = 0.0001), defecation frequency (OR = 4.38; 95% CI: 1.93, 9.93. P = 0.0004), and stool form (OR = 4.96; 95% CI: 2.11, 11.65; P = 0.0002) in the treatment group as compared to the control group. A lower recurrence rate was associated with TCM as compared to cisapride and mosapride (OR = 0.15; 95% CI: 0.08, 0.27; P < 0.00001). No adverse effects were observed during TCM treatment.
CONCLUSIONS
TCM showed greater improvement in terms of clinical efficacy in the treatment of IBS-C than cisapride and mosapride, although it was not possible to draw a definitive conclusion due to the small sample size, high risk, and low quality of the studies. Large multi-center and long-term high-quality randomized control trials are needed.
Topics: Benzamides; Cisapride; Constipation; Humans; Irritable Bowel Syndrome; Medicine, Chinese Traditional; Morpholines; Odds Ratio; Randomized Controlled Trials as Topic
PubMed: 29253850
DOI: 10.1371/journal.pone.0189491 -
Alimentary Pharmacology & Therapeutics Jan 2008Enteral nutrition can be associated with gastrointestinal side effects and fibre supplementation has been proposed as a means to normalize bowel function. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Enteral nutrition can be associated with gastrointestinal side effects and fibre supplementation has been proposed as a means to normalize bowel function.
AIM
To evaluate systematically the effects of fibre supplementation of enteral feeds in healthy volunteers and patients both in the hospital and community settings.
METHODS
Electronic and manual bibliographic searches were conducted. Controlled studies in adults or children, comparing fibre-supplemented vs. fibre-free formulae given as the sole source of nutrition for at least 3 days, were included.
RESULTS
Fifty-one studies (including 43 randomized-controlled trials), enrolling 1762 subjects (1591 patients and 171 healthy volunteers) met the inclusion criteria. Fibre supplementation was generally well tolerated. In the hospital setting, the incidence of diarrhoea was reduced as a result of fibre administration (OR 0.68, 95% CI: 0.48-0.96; 13 randomized-controlled trials). Meta-regression showed a more pronounced effect when the baseline incidence of diarrhoea was high. In both patients and healthy subjects, fibre significantly reduced bowel frequency when baseline frequency was high and increased it when it was low, revealing a significant moderating effect of fibre.
CONCLUSIONS
The review indicates that the fibre-supplemented enteral formulae have important physiological effects and clinical benefits. There is a need to use a consistent approach to undertake more studies on this issue in the community setting.
Topics: Adult; Anti-Bacterial Agents; Child; Constipation; Defecation; Diarrhea; Dietary Fiber; Dose-Response Relationship, Drug; Enteral Nutrition; Fatty Acids, Volatile; Feces; Gastrointestinal Transit; Humans; Incidence; Randomized Controlled Trials as Topic
PubMed: 17922802
DOI: 10.1111/j.1365-2036.2007.03544.x -
Evidence-based Complementary and... 2018Delays in recovery of intestinal function following abdominal surgery are associated with longer hospital stays, increased postoperative complications, and higher costs... (Review)
Review
Delays in recovery of intestinal function following abdominal surgery are associated with longer hospital stays, increased postoperative complications, and higher costs to the health care system. Studies of acupuncture for postoperative ileus and other postoperative issues have reported improvements. This systematic review and meta-analysis aimed to assess whether acupuncture assisted recovery following surgery for colorectal cancer (CRC). Randomized controlled trials (RCTs) were identified from major English and Chinese language biomedical databases. Participants (aged 18 years plus) had received surgical resection for CRC. 22 studies (1,628 participants) were included. Five were sham-controlled. Outcomes included gastrointestinal function recovery (21 studies), recovery of urinary function (1 study), postoperative abdominal distension (3 studies), and quality of life (1 study). Meta-analyses found significant reductions in time to first bowel sounds, first flatus, and first defecation in both the sham-controlled and nonblinded studies. These results suggested that the addition of acupuncture following CRC surgery improved recovery of gastrointestinal function based on four blinded good quality RCTs (281 participants) and 17 nonblinded lower quality RCTs (1,265 participants). The best available evidence was for interventions that included electroacupuncture at the point ST36 and there is supporting evidence for other types of acupuncture therapies that involve stimulation of this point. This review is registered with the following: systematic review registration in PROSPERO: CRD42017079590.
PubMed: 30151019
DOI: 10.1155/2018/3178472