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Minerva Chirurgica 2016 April;71(2):98-105

lingua: Inglese

Psyllium fiber vs. placebo in early treatment after STARR for obstructed defecation: a randomized double-blind clinical trial

Francesco GABRIELLI 1, Daniele MACCHINI 1, Angelo GUTTADAURO 1, Silvia FRASSANI 1, Aimone BERTOLINI 1, Cristiana GIUSSANI 2, Matilde DE SIMONE 3, Ugo CIOFFI 3

1 General Surgery Operative Unit, Istituti Clinici Zucchi, Università degli Studi di Milano-Bicocca, Monza, Italy; 2 Clinical metodologist consultant, Monza, Italy; 3 Università degli Studi di Milano, Milan, Italy


BACKGROUND: Previous Literature has never evaluated the effectiveness of fiber intake after surgery for obstructed defecation in improving residual constipation and defecation urgency.
METHODS: From May 2010 to June 2011, 65 patients were randomly assigned to either the active group (N.=32) or placebo group (N.=33) receiving 3.5 g/day of pure Psyllium fiber or inert compound respectively. During the 6-month follow-up score systems were evaluated: Longo’s Obstructed Defecation Syndrome Score, Cleveland Constipation Score; Wexner incontinence Score and Visual Analogic Scale. We also recorded the incidence of postoperative defecation urgency.
RESULTS: Active group reported less constipation at 1 week (ODS: 6.25±3.55 vs. 11.94±4.99, P<0.01-CCS: 6.59±2.65 vs. 15.10±3.33, P<0.01) and 6 months (ODS: 3.40±5.26 vs. 4.97±4.21, P<0.05-CCS: 5.00±3.82 vs. 6.63±3.68; P<0.01). Wexner Score was better at t-test in the treatment group (difference from baseline: 0.5 vs. 2.70, P<0.01 after 1 week and -0.17 vs. 1.33, P<0.01 after 6 months). Defecation urgency was less frequent in the treatment group (15.62% vs. 42.42%, P<0.05 at the χ2 Test).
CONCLUSIONS: Early treatment with Psyllium fiber improves early and 6 month results after stapled transanal rectal resection, both in terms of residual constipation and fecal incontinence. It also reduces postoperative defecation urgency.

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