BackgroundThe aim of the present study was to make a preoperative and postoperative clinical and functional evaluation of patients who underwent transanal repair of rectocele and rectal mucosectomy with a single circular stapler (TRREMS procedure) as treatment for obstructed defecation syndrome (ODS) caused by rectocele and rectal mucosal prolapse (RMP).MethodsThis prospective study included 35 female patients, 34 multiparous and one nulliparous, with an average age of 47.5 years (range 31–67 years), rectocele grade II (n = 13/37.1%) or grade III (n = 22/62.9%), associated with RMP. The study parameters included ODS, constipation, functional continence scores and pre- and postoperative cinedefecographic findings.ResultsThe average preoperative ODS score, the constipation score and the functional continence score were significantly reduced after surgery from 10.63 to 2.91 (p = 0.001), 15.23 to 4.46 (p = 0.001) and 2.77 to 1.71 (p = 0.001), respectively. Between the first and the eighth postoperative day, the average visual analog scale pain score fell from 5.23 to 1.20 (p = 0.001). Satisfaction with treatment outcome was 79.97, 86.54, 87.65 and 88.06 at 1, 3, 6 and 12 months, respectively. Cinedefecography revealed average reductions in rectocele size from 19.23 ± 8.84 mm (3–42) to 6.68 ± 3.65 mm (range 0–7) at rest and from 34.89 ± 12.30 mm (range 20–70) to 10.94 ± 5.97 mm (range 0–25) during evacuation (both P = 0.001).ConclusionThe TRREMS procedure is a safe and efficient technique associated with satisfactory anatomic and functional results and with a low incidence of postoperative pain and complications.

Current trial results suggest that TRREMS procedure is a safe and effective technique for the treatment of anorectocele associated with mucosa prolapse. The stapling technique is low-cost as requires the use of a single circular stapler.

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RAIR parameters are influenced by the choice of inflation pattern. Further studies are required to establish a standard intrarectal balloon inflation pattern.

Trabalho realizado no Seviço de Colo-Proctologia -Disciplina de Moléstias do Aparelho Digestivo -UNICAMP -SÃO PAULO -BRASIL. Recebido em 09/08/2006 Aceito para publicação em 29/08/2006 INTRODUÇÃOO desenvolvimento de métodos diagnósticos tem proporcionado melhor compreensão da fisiologia anorretal e dos distúrbios da evacuação, com abordagens terapêuticas mais eficazes. Dentre estes, a manometria anorretal possibilita, além das medidas de pressão de repouso e contração voluntária, a pesquisa do reflexo inibitório retoanal (RIRA). Descrito por Gowers em 1887 16 e posteriormente confirmado por Denny-Brown e Robertson 9 em 1935, sua importância tem sido enfatizada nos mecanismos de evacuação e continência (18,33,44). Ocorrendo a distensão do reto, segue-se o relaxamento do esfíncter anal interno, permitindo contato do conteúdo retal com a porção proximal do canal anal (24). Assim, estimulam-se terminações nervosas que transmitirão a discriminação deste conteúdo, permitindo a diferenciação entre gases e fezes sólidas ou líquidas (11,25).No entanto, apesar da importância do RIRA no mecanismo da evacuação, este reflexo vem sendo pouco explorado pelos pesquisadores, sendo na maio-