[Treatment of rectocele and rectal mucosal prolapse with mucosal flaps excision and with manual reconstruction]

BACKGROUND

Rectocele is defined as an erniation of the anterior rectal and vaginal wall in the vaginal lumen due to the loss of rectovaginal septum. Rectal mucosal prolapse was characterized by the protrusion of the mucosa alone in the rectal lumen. The Authors, herein, reported the results of a new surgical technique with the excision of one or more mucosal or muco-muscolar flaps and reconstruction with Sequential Transfixed Stitch Technique (STST) using a anal retractor designed by them.

MATERIALS AND METHODS

The new surgical technique was applied to 40 consecutive patients with rectal mucosal prolapse and 20 with symptomatic rectocele of III degree assessed with proctological evaluation, digital examination of the anal canal, sphere test, defecography and total colonoscopy were submitted to STST. Patients with previous colorectal or pelvic surgery were excluded from the study. The quality of life was defined using a questionnaire before surgery, at 3 and 6 months of follow-up. Data were evaluated according to the Agachan-Wexner score.

RESULTS

The new technique was correctly performed in all the cases without early and late complications. The mean value was of 18.2 according to the Agachan-Wexner for patients with rectocele and 17.6 for rectal mucosal prolapse, both significantly improved score in comparison to pre-operatory condition (p<0.05). Surgical procedure with flaps excision and manual procedure of STST was judged satisfactory in 89% of the cases.

CONCLUSIONS

The treatment of symptomatic rectocele and rectal mucosal prolapse with multiple excision of exceeding tissue flaps and the reconstruction with STST manually conducted showed optimal results for the surgical treatment of in our experience with a significant improvement of quality of life referred by the patients and absence of significant post-operative side effects.

[Quality of life, symptoms of dyschezia, and anatomy after correction of rectal motility disorder]

AIM OF THE STUDY

To evaluate the quality of life of patients suffering from dyschezia and its correlation with symptomatic complaints and anatomical abnormalities, before and after elective surgery for rectal static disorder.

PATIENTS AND METHODS

A prospective study was conducted using a general quality of life questionnaire (SF36) and a constipation specific score (PAC-QoL), a dyschezia symptom score, and defecography.

RESULTS

Thirty-eight female dyschesic patients (mean age 54 years) underwent surgery for rectocele with (n=16) or without (n=14) internal rectal prolapse, an isolated internal rectal prolapse (n=3), or a total rectal prolapse (n=5). Preoperative quality of life was low, correlated with the intensity of dyschezia. Seven months after surgery, quality of life and dyschezia improved independently of the amplitude of the anatomical correction. More items improved in the constipation specific score than on the quality of life questionnaire; they were correlated with the course of dyschezia symptoms. Neither incontinence nor irritable bowel syndrome affected evolution of the symptoms.

CONCLUSION

Surgery improved initially low quality of life and symptomatic complaints in patients with dyschezia and a rectal static disorder, independently of anatomic repair. Differences in changes observed in the PAC-QoL and SF36 suggest different fields of application.

[Rectal prolapse: etiopathogenetic and therapeutic problems in psychiatric patients]

Rectum prolapse is a pathological condition which has long been considered as rare but whose occurrence has been progressively increasing in the past decades. There still exists a degree of uncertainty as to the disease etiopathology: moreover the exact relationship between rectum prolapse and psychic disorders which have been found in up to 50% of the patients with prolapse has not been clarified. Neither on the therapeutic level is there a common opinion as to the ideal surgical approach and over one hundred techniques have been suggested for the surgical correction of the prolapse. A study has been carried out on 10 patients suffering from psychiatric pathology of different kinds (oligophrenia, schizophrenic psychosis), hospitalized at Istituti Ospedalieri Opera Don Uva in Bisceglie. They suffered from complete rectum prolapse and underwent surgical intervention. In this study the etiopathogenetic problems of prolapse are investigated according to recent developments, with particular reference to the very peculiar implications they have in the psychiatric patient. Finally the surgical techniques correctly used and their possible application in the psychiatric patient are examined.