Therapeutic Effects of the TST36 Stapler on Rectocele Combined with Internal Rectal Prolapse

Overview

Journal World J Gastrointest Surg

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2021 Jun 14

PMID 34122734

Authors

Jin Meng

Zhi-Tao Yin

Ying-Yi Zhang

Yong Zhang

Xiu Zhao

Qing Zhai

De-Yu Chen

Wei-Gang Yu

Lei Wang

Zhi-Gang Wang

Affiliations

Soon will be listed here.

Abstract

Background: The most common causes of outlet obstructive constipation (OOC) are rectocele and internal rectal prolapse. The surgical methods for OOC are diverse and difficult, and the postoperative complications and recurrence rate are high, which results in both physical and mental pain in patients. With the continuous deepening of the surgeon's concept of minimally invasive surgery and continuous in-depth research on the mechanism of OOC, the treatment concepts and surgical methods are continuously improved.

Aim: To determine the efficacy of the TST36 stapler in the treatment of rectocele combined with internal rectal prolapse.

Methods: From January 2017 to July 2019, 49 female patients with rectocele and internal rectal prolapse who met the inclusion criteria were selected for treatment using the TST36 stapler.

Results: Forty-five patients were cured, 4 patients improved, and the cure rate was 92%. The postoperative obstructed defecation syndrome score, the defecation frequency score, time/straining intensity, and sensation of incomplete evacuation were significantly decreased compared with these parameters before treatment, and the differences were statistically significant ( < 0.05). The postoperative anal canal resting pressure and maximum squeeze pressure in patients decreased compared with before treatment, and the differences were statistically significant ( < 0.05). The initial and maximum defecation thresholds after surgery were significantly lower than those before treatment, and the differences were statistically significant ( < 0.05). The postoperative ratings of rectocele, resting phase, and defecation phase in these patients were significantly decreased compared with those before treatment, and the differences were statistically significant ( < 0.05).

Conclusion: The TST36 stapler is safe and effective in treating rectocele combined with internal rectal prolapse and is worth promoting in clinical work.

References

Heinrich H, Sauter M, Fox M, Weishaupt D, Halama M, Misselwitz B . Assessment of Obstructive Defecation by High-Resolution Anorectal Manometry Compared With Magnetic Resonance Defecography. Clin Gastroenterol Hepatol. 2015; 13(7):1310-1317.e1. DOI: 10.1016/j.cgh.2015.01.017. View

Chiarioni G, Whitehead W, Pezza V, Morelli A, Bassotti G . Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology. 2006; 130(3):657-64. DOI: 10.1053/j.gastro.2005.11.014. View

Zhang G, Liang R, Wang J, Ke M, Chen Z, Huang J . Network meta-analysis of randomized controlled trials comparing the procedure for prolapse and hemorrhoids, Milligan-Morgan hemorrhoidectomy and tissue-selecting therapy stapler in the treatment of grade III and IV internal hemorrhoids(Meta-analysis). Int J Surg. 2019; 74:53-60. DOI: 10.1016/j.ijsu.2019.12.027. View

Naldini G, Fabiani B, Menconi C, Giani I, Toniolo G, Martellucci J . Tailored prolapse surgery for the treatment of hemorrhoids with a new dedicated device: TST Starr plus. Int J Colorectal Dis. 2015; 30(12):1723-8. DOI: 10.1007/s00384-015-2314-7. View

van Gruting I, Stankiewicz A, Kluivers K, De Bin R, Blake H, Sultan A . Accuracy of Four Imaging Techniques for Diagnosis of Posterior Pelvic Floor Disorders. Obstet Gynecol. 2017; 130(5):1017-1024. DOI: 10.1097/AOG.0000000000002245. View

Karlbom U, Graf W, Nilsson S, Pahlman L . The accuracy of clinical examination in the diagnosis of rectal intussusception. Dis Colon Rectum. 2004; 47(9):1533-8. DOI: 10.1007/s10350-004-0626-8. View

Boccasanta P, Agradi S, Vergani C, Calabro G, Bordoni L, Missaglia C . The evolution of transanal surgery for obstructed defecation syndrome: Mid-term results from a randomized study comparing double TST 36 HV and Contour TRANSTAR staplers. Am J Surg. 2018; 216(5):893-899. DOI: 10.1016/j.amjsurg.2018.01.074. View

Longstreth G, Grant Thompson W, Chey W, Houghton L, Mearin F, Spiller R . Functional bowel disorders. Gastroenterology. 2006; 130(5):1480-91. DOI: 10.1053/j.gastro.2005.11.061. View

Pescatori M, Zbar A . Tailored surgery for internal and external rectal prolapse: functional results of 268 patients operated upon by a single surgeon over a 21-year period*. Colorectal Dis. 2008; 11(4):410-9. DOI: 10.1111/j.1463-1318.2008.01626.x. View

10.

Higgins P, Johanson J . Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol. 2004; 99(4):750-9. DOI: 10.1111/j.1572-0241.2004.04114.x. View

11.

Youssef M, Emile S, Thabet W, Elfeki H, Magdy A, Omar W . Comparative Study Between Trans-perineal Repair With or Without Limited Internal Sphincterotomy in the Treatment of Type I Anterior Rectocele: a Randomized Controlled Trial. J Gastrointest Surg. 2016; 21(2):380-388. DOI: 10.1007/s11605-016-3299-4. View

12.

Ng Z, Levitt M, Tan P, Makin G, Platell C . Long-term outcomes of surgical management of rectal prolapse. ANZ J Surg. 2019; 89(6):E231-E235. DOI: 10.1111/ans.15264. View

13.

Leanza V, Intagliata E, Leanza G, Cannizzaro M, Zanghi G, Vecchio R . Surgical repair of rectocele. Comparison of transvaginal and transanal approach and personal technique. G Chir. 2013; 34(11-12):332-6. PMC: 3926474. View

14.

Mustain W . Functional Disorders: Rectocele. Clin Colon Rectal Surg. 2017; 30(1):63-75. PMC: 5179273. DOI: 10.1055/s-0036-1593425. View

15.

Pomerri F, Zuliani M, Mazza C, Villarejo F, Scopece A . Defecographic measurements of rectal intussusception and prolapse in patients and in asymptomatic subjects. AJR Am J Roentgenol. 2001; 176(3):641-5. DOI: 10.2214/ajr.176.3.1760641. View

16.

Dietz H, Beer-Gabel M . Ultrasound in the investigation of posterior compartment vaginal prolapse and obstructed defecation. Ultrasound Obstet Gynecol. 2011; 40(1):14-27. DOI: 10.1002/uog.10131. View

17.

Gultekin F . Short term outcome of laparoscopic ventral mesh rectopexy for rectal and complex pelvic organ prolapse: case series. Turk J Surg. 2020; 35(2):91-97. PMC: 6796075. DOI: 10.5578/turkjsurg.4157. View

18.

Sangster P, Morley R . Biomaterials in urinary incontinence and treatment of their complications. Indian J Urol. 2010; 26(2):221-9. PMC: 2938547. DOI: 10.4103/0970-1591.65394. View

19.

Formijne Jonkers H, Poierrie N, Draaisma W, Broeders I, Consten E . Laparoscopic ventral rectopexy for rectal prolapse and symptomatic rectocele: an analysis of 245 consecutive patients. Colorectal Dis. 2013; 15(6):695-9. DOI: 10.1111/codi.12113. View

20.

Pechlivanides G, Tsiaoussis J, Athanasakis E, Zervakis N, Gouvas N, Zacharioudakis G . Stapled transanal rectal resection (STARR) to reverse the anatomic disorders of pelvic floor dyssynergia. World J Surg. 2007; 31(6):1329-35. DOI: 10.1007/s00268-007-9021-7. View