J Martellucci, E Falletto, S Ascanelli, A Bondurri, S Borin, C Bottini, E Caproli, M Carrera, G Cestaro, L Chimisso, G Clarizia, I Clementi, S Cornaglia, S Costa, G Gallo, C Guerci, C Lambiase, A Lauretta, P Luffarelli, M C Neri, D Piccolo, E Rosati, P Rossitti, A Spolini, G Torchia, E Valloncini, D Zattoni, E Zucchi, P Biotti, A Cambareri, G Coniglio, A Coppola, K Nepote Fus, S Graziani, M Grilli, A Grego, E Guerra, E Livio, L Manganini, P Mazzeo, A Minonne, M Mirafiori, G Negri, V Palazzolo, C Di Pasquale, V Tantolo
{"title":"经肛门灌洗低位前切除综合征和功能性便秘患者的共识驱动方案。","authors":"J Martellucci, E Falletto, S Ascanelli, A Bondurri, S Borin, C Bottini, E Caproli, M Carrera, G Cestaro, L Chimisso, G Clarizia, I Clementi, S Cornaglia, S Costa, G Gallo, C Guerci, C Lambiase, A Lauretta, P Luffarelli, M C Neri, D Piccolo, E Rosati, P Rossitti, A Spolini, G Torchia, E Valloncini, D Zattoni, E Zucchi, P Biotti, A Cambareri, G Coniglio, A Coppola, K Nepote Fus, S Graziani, M Grilli, A Grego, E Guerra, E Livio, L Manganini, P Mazzeo, A Minonne, M Mirafiori, G Negri, V Palazzolo, C Di Pasquale, V Tantolo","doi":"10.1007/s10151-024-03033-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>This study aims to establish a consensus-based standard protocol for transanal irrigation (TAI) in patients with low anterior resection syndrome (LARS) and functional constipation.</p><p><strong>Methods: </strong>The Delphi method was utilized to reach a consensus among clinicians and nurses expert in the field of colorectal surgery and gastroenterology. To address various uncertainties concerning technical aspects, difficulties, and prescription of TAI, two questionnaires were developed and analyzed in two rounds. A binary approach was employed, setting a consensus threshold of 75% agreement.</p><p><strong>Results: </strong>In the first round, nurses achieved consensus on all statements, while clinicians required a second round to reach consensus, particularly regarding prescription and technical aspects. Clinicians reached consensus on prescribing TAI as a second-line treatment for LARS and functional constipation, following the failure of conservative measures such as dietary and lifestyle interventions. Timing considerations for patients with LARS encompass avoiding TAI within 1 month of stoma closure and waiting a minimum of 3 months. For functional constipation, TAI is recommended for slow transit constipation, emphasizing its preference over surgical options. 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引用次数: 0
摘要
背景：本研究旨在为低位前切除综合征（LARS）和功能性便秘患者建立基于共识的经肛门灌洗（TAI）标准方案：本研究旨在为低位前切除综合征（LARS）和功能性便秘患者的经肛门灌洗（TAI）制定基于共识的标准方案：方法：采用德尔菲法在结直肠外科和胃肠病学领域的临床医生和护士专家之间达成共识。为了解决有关 TAI 技术方面、难度和处方的各种不确定性，我们编制了两份问卷，并分两轮进行了分析。采用二进制方法，设定的共识阈值为 75%：结果：在第一轮调查中，护士对所有陈述都达成了共识，而临床医生则需要第二轮调查才能达成共识，尤其是在处方和技术方面。临床医生达成的共识是，在饮食和生活方式干预等保守措施失败后，将TAI作为治疗LARS和功能性便秘的二线疗法。对 LARS 患者的时机考虑包括避免在造口关闭后 1 个月内进行 TAI，并至少等待 3 个月。对于功能性便秘，建议采用 TAI 治疗慢传输性便秘，并强调 TAI 比手术治疗更有优势。此外，还就 LARS 患者导管的选择、患者和护理人员的培训要求、TAI 前患者肠道的准备以及推荐的灌洗方法达成了共识：这项共识研究成功制定了针对 LARS 和功能性便秘的标准化 TAI 方案。它为处方和技术方面提供了全面的指导，解决了医护人员遇到的难题。该方案旨在加强对患者的护理，改善治疗效果，促进 TAI 的发展。
Consensus-driven protocol for transanal irrigation in patients with low anterior resection syndrome and functional constipation.
Background: This study aims to establish a consensus-based standard protocol for transanal irrigation (TAI) in patients with low anterior resection syndrome (LARS) and functional constipation.
Methods: The Delphi method was utilized to reach a consensus among clinicians and nurses expert in the field of colorectal surgery and gastroenterology. To address various uncertainties concerning technical aspects, difficulties, and prescription of TAI, two questionnaires were developed and analyzed in two rounds. A binary approach was employed, setting a consensus threshold of 75% agreement.
Results: In the first round, nurses achieved consensus on all statements, while clinicians required a second round to reach consensus, particularly regarding prescription and technical aspects. Clinicians reached consensus on prescribing TAI as a second-line treatment for LARS and functional constipation, following the failure of conservative measures such as dietary and lifestyle interventions. Timing considerations for patients with LARS encompass avoiding TAI within 1 month of stoma closure and waiting a minimum of 3 months. For functional constipation, TAI is recommended for slow transit constipation, emphasizing its preference over surgical options. Consensus was also reached on the choice of catheter for patients with LARS, training requirements for patients and caregivers, preparation of the patient's intestine before TAI, and recommended irrigations.
Conclusions: This consensus study successfully developed a standardized TAI protocol for LARS and functional constipation. It provides comprehensive guidelines for prescription and technical aspects, addressing the challenges encountered by healthcare professionals. The protocol aims to enhance patient care, improve treatment outcomes, and contribute to the advancement of TAI.
期刊介绍：
Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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