Treatment strategies for chronic constipation: our experience.

Outlet dysfunction is responsible for 25% of all cases of chronic constipation. The aim of this article was to report our outcomes and investigate the efficacy of the different treatments that we have adopted to solve it. One hundred and twenty-six patients were treated with either surgery and/or biofeedback therapy. Ninety-seven of the 126 patients underwent surgery; 48 with hidden rectal prolapse: 44 underwent a stapled transanal rectal resection using a double stapler PPH-01 and 4 a single stapler PPH-01; 31 with rectocele and 18 with both hidden rectal prolapse and rectocele, respectively, underwent a stapled transanal rectal resection using a double stapler PPH-01. Thirteen of 97 patients showing outlet dysfunction in spite of surgery progressed to biofeedback therapy. 29 of the 126 patients were treated with biofeedback training only. Surgery helped 51.6% of treated for rectocele, 75% of those treated for hidden rectal prolapse, and 78% of patients treated for both rectocele and hidden rectal prolapse, respectively. Approximately 80% of patients treated with biofeedback alone and 67.8% of those treated with both surgery and biofeedback reported an improvement, respectively. Treatment of the outlet dysfunction can be difficult. The therapeutic option chosen for each subject in spite of a careful functional patient examination may not prove to be the most appropriate one. Our experience suggests that the surgery of the obstructed defecation could achieve better outcomes if a course of biofeedback therapy precedes it, above all in patients with both organic and functional disorders, and the repair of rectocele with stapled transanal rectal resection fails to resolve the outlet dysfunction in several cases.