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)

Overview

Journal Tech Coloproctol

Date 2010 Oct 20

PMID 20957403

Citations 9

Authors

V M Leal

F S P Regadas

S M M Regadas

L R Veras

Affiliations

Soon will be listed here.

Abstract

Background: The 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).

Methods: This 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.

Results: The 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).

Conclusion: The 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.

Citing Articles

Current diagnostic tools and treatment modalities for rectal prolapse.

Oruc M, Erol T World J Clin Cases. 2023; 11(16):3680-3693.

PMID: 37383136 PMC: 10294152. DOI: 10.12998/wjcc.v11.i16.3680.

Impact of TRREMS on symptoms of obstructed defecation due to rectocele: predictive factors and outcomes.

Regadas F, Murad-Regadas S, Rodrigues L, Regadas Filho F, Vilarinho A, Morano D Tech Coloproctol. 2019; 24(1):65-73.

PMID: 31828573 DOI: 10.1007/s10151-019-02131-6.

Surgical interventions for posterior compartment prolapse and obstructed defecation symptoms: a systematic review with clinical practice recommendations.

Grimes C, Schimpf M, Wieslander C, Sleemi A, Doyle P, Wu Y Int Urogynecol J. 2019; 30(9):1433-1454.

PMID: 31256222 DOI: 10.1007/s00192-019-04001-z.

Abdominal Approaches to Rectal Prolapse.

Joubert K, Laryea J Clin Colon Rectal Surg. 2017; 30(1):57-62.

PMID: 28144213 PMC: 5179275. DOI: 10.1055/s-0036-1593426.

Transanal surgery for obstructed defecation syndrome: Literature review and a single-center experience.

Liu W, Wan S, Yaseen S, Ren X, Tian C, Ding Z World J Gastroenterol. 2016; 22(35):7983-98.

PMID: 27672293 PMC: 5028812. DOI: 10.3748/wjg.v22.i35.7983.

References

Jensen M, Karoly P, Braver S . The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986; 27(1):117-126. DOI: 10.1016/0304-3959(86)90228-9. View

Murad-Regadas S, Regadas F, Rodrigues L, Oliveira L, Barreto R, de Souza M . Types of pelvic floor dysfunctions in nulliparous, vaginal delivery, and cesarean section female patients with obstructed defecation syndrome identified by echodefecography. Int J Colorectal Dis. 2009; 24(10):1227-32. DOI: 10.1007/s00384-009-0746-7. View

Zhang B, Ding J, Yin S, Zhang M, Zhao K . Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception. World J Gastroenterol. 2010; 16(20):2542-8. PMC: 2877185. DOI: 10.3748/wjg.v16.i20.2542. View

Pescatori M, Gagliardi G . Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Tech Coloproctol. 2008; 12(1):7-19. PMC: 2778725. DOI: 10.1007/s10151-008-0391-0. View

Renzi A, Talento P, Giardiello C, Angelone G, Izzo D, Di Sarno G . Stapled trans-anal rectal resection (STARR) by a new dedicated device for the surgical treatment of obstructed defaecation syndrome caused by rectal intussusception and rectocele: early results of a multicenter prospective study. Int J Colorectal Dis. 2008; 23(10):999-1005. DOI: 10.1007/s00384-008-0522-0. View

Boccasanta P, Venturi M, Stuto A, Bottini C, Caviglia A, Carriero A . Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial. Dis Colon Rectum. 2004; 47(8):1285-96. DOI: 10.1007/s10350-004-0582-3. View

JORGE J, Wexner S . Etiology and management of fecal incontinence. Dis Colon Rectum. 1993; 36(1):77-97. DOI: 10.1007/BF02050307. View

Dindo D, Weishaupt D, Lehmann K, Hetzer F, Clavien P, Hahnloser D . Clinical and morphologic correlation after stapled transanal rectal resection for obstructed defecation syndrome. Dis Colon Rectum. 2008; 51(12):1768-74. DOI: 10.1007/s10350-008-9412-3. View

Regadas F, Regadas S, Rodrigues L, Misici R, Silva F, Regadas Filho F . Transanal repair of rectocele and full rectal mucosectomy with one circular stapler: a novel surgical technique. Tech Coloproctol. 2005; 9(1):63-6. DOI: 10.1007/s10151-005-0197-2. View

10.

Soares F, Regadas F, Murad-Regadas S, Rodrigues L, Silva F, Escalante R . Role of age, bowel function and parity on anorectocele pathogenesis according to cinedefecography and anal manometry evaluation. Colorectal Dis. 2009; 11(9):947-50. DOI: 10.1111/j.1463-1318.2008.01761.x. View

11.

Corman M, Carriero A, Hager T, Herold A, Jayne D, Lehur P . Consensus conference on the stapled transanal rectal resection (STARR) for disordered defaecation. Colorectal Dis. 2006; 8(2):98-101. DOI: 10.1111/j.1463-1318.2005.00941.x. View

12.

Ommer A, Albrecht K, Wenger F, Walz M . Stapled transanal rectal resection (STARR): a new option in the treatment of obstructive defecation syndrome. Langenbecks Arch Surg. 2006; 391(1):32-7. DOI: 10.1007/s00423-005-0004-6. View

13.

Khubchandani I, Clancy 3rd J, Rosen L, Riether R, Stasik Jr J . Endorectal repair of rectocele revisited. Br J Surg. 1997; 84(1):89-91. DOI: 10.1046/j.1365-2168.1997.02463.x. View

14.

Richardson A . The rectovaginal septum revisited: its relationship to rectocele and its importance in rectocele repair. Clin Obstet Gynecol. 1993; 36(4):976-83. DOI: 10.1097/00003081-199312000-00022. View

15.

Lenisa L, Schwandner O, Stuto A, Jayne D, Pigot F, Tuech J . STARR with Contour Transtar: prospective multicentre European study. Colorectal Dis. 2009; 11(8):821-7. PMC: 2774156. DOI: 10.1111/j.1463-1318.2008.01714.x. View

16.

Gagliardi G, Pescatori M, Altomare D, Binda G, Bottini C, Dodi G . Results, outcome predictors, and complications after stapled transanal rectal resection for obstructed defecation. Dis Colon Rectum. 2007; 51(2):186-95. DOI: 10.1007/s10350-007-9096-0. View

17.

Agachan F, Chen T, Pfeifer J, Reissman P, Wexner S . A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum. 1996; 39(6):681-5. DOI: 10.1007/BF02056950. View

18.

Hausammann R, Steffen T, Weishaupt D, Beutner U, Hetzer F . Rectocele and intussusception: is there any coherence in symptoms or additional pelvic floor disorders?. Tech Coloproctol. 2009; 13(1):17-25. DOI: 10.1007/s10151-009-0454-x. View

19.

Boccasanta P, Venturi M, Salamina G, Cesana B, Bernasconi F, Roviaro G . New trends in the surgical treatment of outlet obstruction: clinical and functional results of two novel transanal stapled techniques from a randomised controlled trial. Int J Colorectal Dis. 2004; 19(4):359-69. DOI: 10.1007/s00384-003-0572-2. View

20.

Zbar A, Lienemann A, Fritsch H, Beer-Gabel M, Pescatori M . Rectocele: pathogenesis and surgical management. Int J Colorectal Dis. 2003; 18(5):369-84. DOI: 10.1007/s00384-003-0478-z. View