Clinical and functional evaluation of patients with rectocele and mucosal prolapse treated with transanal repair of rectocele and rectal mucosectomy with a single circular stapler (TRREMS)

Abstract

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.

Apex Technique in the Treatment of Obstructed Defecation Syndrome Associated With Rectal Intussusception and Full Rectal Mucosa Prolapse

“…in a prospective multicenter study of 75 patients with anorectocele associated with mucosal prolapse or rectal intussusception, 20 the mean agachan-Wexner constipation score decreased significantly (from 16 to 4; p = 0.001), and the authors concluded that the tRRems procedure is a safe and effective technique, capable of restoring the anatomic integrity of the anal canal. another study 21 in patients with grade ii or iii rectocele also demonstrated significant reductions in the mean constipation score (from 15.23 to 4.46; p = 0.001) and in the mean obstructed defecation score 12 (from 10.6 to 2.9; p = 0.001) with the tRRems procedure. Compared with staRR, the tRRems procedure has the advantage of lower costs because it requires only 1 circular stapler.…”

“…[19][20][21] We have further modified the tRRems procedure to be used mainly in those patients with rectal intussusception, because it is a faster, simpler technique using 1 circular stapler that accepts a large volume of tissue without requiring any manual resection with a running suture of the anterior anorectal quadrant. the aim of the current study was to demonstrate the use of this modified stapling technique, which we call the apex technique, to treat patients with obstructed defecation caused by rectal intussusception and full rectal mucosal prolapse (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/a158).…”

Indikationen und chirurgische Therapieoptionen beim obstruktiven Defäkationssyndrom

“…-Sets (Ethicon Endo-Surgery, Norderstedt, Deutschland) durchführen, wobei zuerst eine segmentale bzw. semizirkuläre Vollwandresektion der Rektumvorderwand nationen existieren [22][23][24][25][26]. Generell werden die chirurgischen Therapieoptionen bei der Rektozele kontrovers diskutiert, wobei die Fokussierung auf eine Rektozele als singuläre Ursache der Entleerungsstörung häufig nicht zum therapeutischen Erfolg führt [22,23].…”

The role of hemorrhoidectomy in rectocele complicated by grade 3–4 hemorrhoids

“…We read with great interest the article by Leal et al [1] in which the authors concluded that the transanal repair of rectocele and rectal mucosectomy with a single circular stapler (TRREMS procedure) has satisfactory anatomic and functional results with a low incidence of postoperative pain and complications.…”