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Regadas FSP, Murad-Regadas SM, Rodrigues LV, Regadas Filho FSP, Vilarinho AS, Morano DP. Impact of TRREMS on symptoms of obstructed defecation due to rectocele: predictive factors and outcomes. Tech Coloproctol 2019; 24:65-73. [PMID: 31828573 DOI: 10.1007/s10151-019-02131-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 11/25/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of the transanal repair of rectocele and rectal mucosectomy with a single circular stapler (TRREMS) on the treatment of obstructed defecation due to rectocele and to identify the predictive factors for unsuccessful results. METHODS Consecutive patients with obstructed defecation symptoms (ODS) associated with rectocele who had the TRREMS procedure were included. Each patient was assessed by echodefecography, manometry, and colonic transit time as well as the Cleveland Clinic constipation score (CCS) before therapy and at follow-up after 6 months. Reduction in the CCS score was calculated as a ratio. Factors correlated with a decrease in the CCS were analyzed in a univariate analysis. RESULTS A total of 81 patients were included. Nineteen patients had postoperative complications that were not severe: 7 (8.6%) had tenesmus, 6 (7.4%) stenosis (4 treated with digital dilatation and 2 with endoscopic stricturectomy), 4 (4.9%) residual mucosal prolapse treated with rubber band ligation, 1 (1.2%) early bleeding, and 1(1.2%) thrombosis. Seventy-nine (97.5%) patients had a significant clinical response with significant reduction of the CCS constipation score from median 13 (range 17-10) to 4 (range, 8-2) (p = 0.0001); only 2 patients (2.5%) had an unsatisfactory response, complaining of straining and vaginal digitation during the evacuatory effort. Patients with anismus previously treated with biofeedback had a lower reduction ratio of the CCS score compared with patients without anismus (61.2 ± 2.8% versus 70.9% ± 1.5, p = 0.0006). There were no significant differences in the reduction of the CCS according to age, parity, type of delivery, previous hysterectomy, post-menopausal status, rectal mucosal prolapse and/or associated rectal intussusception, grade of rectocele and presence of complications. CONCLUSIONS The TRREMS procedure significantly improved evacuation disorders in this study. Appropriate selection of patients is key for the success of this approach. Anismus even if previously treated with biofeedback, was the main predictive factor of unsuccessful treatment.
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Affiliation(s)
- F S P Regadas
- Department of Surgery, School of Medicine, School of Medicine of the Federal University of Ceará, Av Atilano de Moura 430, Fortaleza, Ceará, 60810-180, Brazil.
- Department of Colorectal Surgery, Sao Carlos Hospital, Fortaleza, CE, Brazil.
| | - S M Murad-Regadas
- Department of Surgery, School of Medicine, School of Medicine of the Federal University of Ceará, Av Atilano de Moura 430, Fortaleza, Ceará, 60810-180, Brazil
- Unit of Pelvic Floor and Anorectal Physiology, Clinical Hospital, Federal University of Ceará, Fortaleza, CE, Brazil
- Department of Colorectal Surgery, Sao Carlos Hospital, Fortaleza, CE, Brazil
| | - L V Rodrigues
- Department of Surgery, School of Medicine, School of Medicine of the Federal University of Ceará, Av Atilano de Moura 430, Fortaleza, Ceará, 60810-180, Brazil
- Department of Colorectal Surgery, Sao Carlos Hospital, Fortaleza, CE, Brazil
| | - F S P Regadas Filho
- Department of Surgery, School of Medicine, School of Medicine of the Federal University of Ceará, Av Atilano de Moura 430, Fortaleza, Ceará, 60810-180, Brazil
- Department of Colorectal Surgery, Sao Carlos Hospital, Fortaleza, CE, Brazil
| | - A S Vilarinho
- Department of Surgery, School of Medicine, School of Medicine of the Federal University of Ceará, Av Atilano de Moura 430, Fortaleza, Ceará, 60810-180, Brazil
- Department of Colorectal Surgery, Sao Carlos Hospital, Fortaleza, CE, Brazil
| | - D P Morano
- Department of Surgery, School of Medicine, School of Medicine of the Federal University of Ceará, Av Atilano de Moura 430, Fortaleza, Ceará, 60810-180, Brazil
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Abstract
INTRODUCTION AND HYPOTHESIS A rectocele is the bulging of the anterior rectal wall into the posterior vaginal compartment. The route of surgical repair can be transvaginal, transrectal or abdominal. The aim of this retrospective study is to describe a novel transvaginal surgical procedure and investigate the associated subjective and objective clinical outcomes. METHODS Database records were retrieved for all women who underwent a rectocele plication for the period from January 2010 until December 2015 in a referral urogynecology unit with a minimum follow-up period of 12 months. This transvaginal technique entails a plication of the anterior rectal wall by suturing of the rectal muscularis layer. Clinical findings and quality of life (QOL) metrics were evaluated and reported on. RESULTS One hundred thirty-nine women met the initial inclusion criteria with full data available for 123. The presenting symptoms included a vaginal bulge in 73 (52.5%), overactive bladder (OAB) in 73 (52.5%), obstructed defecation (OD) in 49 (35.3%) and anal incontinence (AI) in 35 (25.2%). The majority of women (n = 72, 51.8%) had stage 3-4 posterior prolapse. The mean follow-up period was 27 ± 15 months. The postoperative symptoms were significantly improved for all, except AI (p = 0.43). There was a significant improvement in posterior prolapse (p < 0.001) with the majority of women noted to have a stage 0 or 1 (n = 109; 88.6%) posterior prolapse at follow-up. CONCLUSIONS The rectocele plication is a novel surgical technique with good subjective and objective clinical outcomes in the medium term.
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Murad-Regadas SM, Rodrigues LV, Furtado DC, Regadas FSP, Olivia da S. Fernandes G, Regadas Filho FSP, Gondim AC, de Paula Joca da Silva R. The influence of age on posterior pelvic floor dysfunction in women with obstructed defecation syndrome. Tech Coloproctol 2012; 16:227-32. [DOI: 10.1007/s10151-012-0831-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 03/16/2012] [Indexed: 10/28/2022]
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