Top

Techniques in Coloproctology

Published in:

01-04-2016 | Original Article

Rectocele repair with stapled transvaginal rectal resection

Authors: A. A. Shafik, O. El Sibai, I. A. Shafik

Published in: Techniques in Coloproctology | Issue 4/2016

Abstract

Background

Constipation is a clinical symptom in patients suffering from slow transit and/or obstructed defecation. Proper treatment requires the identification of all associated disorders and the quantification of symptoms. Rectocele can cause the symptoms of obstructed defecation syndrome (ODS). The aim of this study was to evaluate the clinical and functional outcomes of a novel technique of transvaginal stapled rectal resection (TVSRR) using a straight staple line, to treat rectocele.

Methods

The study included 84 females [median age 51 years (range 29–73 years)], with obstructed defecation, grades II–III rectocele, and multiple abnormalities on defecography. The magnitude and degree of ODS were quantified by the Altomare ODS scoring system. Continence status was evaluated using the Pescatori scoring system. The rectal and vaginal manometric study, the index of patient satisfaction using a visual analog score (VAS), and the validated Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire results were recorded. All patients underwent TVSRR.

Results

There were no intraoperative complications. Early postoperative complications were defecatory urgency in seven patients (8.3 %), dyspareunia in two (2.4 %), and rectovaginal fistula in one (1.2 %). Five patients (6 %) had recurrence of ODS symptoms. There was no significant change in continence pre- and postoperatively. The ODS score and VAS revealed significant improvement within the first postoperative year in 94 % of patients. The PAC-QOL questionnaire mean total scores indicated an improvement in both the patient satisfaction and the QOL during the 12-month follow-up. The self-reported definitive outcome was excellent in 46 patients (54.7 %), good in 29 (34.5 %), fairly good in 20 (23.8 %), and poor in five (6.0 %).

Conclusions

Vaginal repair carries no risk of fecal incontinence. Large anterior rectocele is considered the main indication for this technique. Using the linear stapler is a cost-effective, simple, and easy technique.

Andromanakos N, Skandalakis P, Troupis T, Filippou D (2006) Constipation of anorectal outlet obstruction: pathophysiology, evaluation and management. J Gastroenterol Hepatol 21:638–646CrossRefPubMed

Murad-Regadas SM, Regadas FSP, Rodrigues LV, Fernandes GOS, Buchen G, Kenmoli M (2012) Management of patients with rectocele, multiple pelvic floor dysfunction and obstructed defecation syndrome. Arq Gastroenterol 49:135–142CrossRefPubMed

Rotholtz NA, Efron JE, Weiss EG, Nogueras JJ, Wexner SD (2002) Anal manometric predictors of significant rectocele in constipated patients. Tech Coloproctol 6:73–77CrossRefPubMed

Seong MK, Kim TW (2013) Significance of defecographic parameters in diagnosing pelvic floordyssynergia. J Korean Surg Soc 84:225–230CrossRefPubMedPubMedCentral

Talley NJ, Weaver AL, Zinsmeister AR, Melton LJ (1993) Functional constipation and outlet delay: a population study. Gastroenterology 105:781–790CrossRefPubMed

Higgins PN, Johanson JF (2004) Epidemiology of constipation in North America: a systemic review. Am J Gastroentrol 99:750–759CrossRef

Schwandner O, Stuto A, Jayne D et al (2008) Decision-making algorithm for the STARR procedure in obstructed defecation syndrome: position statement of the group of STARR Pioneers. SurgInnov 15:105–109

Pescatori M, Spyrou M, Pulvirenti d’Uso A (2006) A prospective evaluation of occult disorders in obstructed defecation using “Iceberg diagram”. Colorectal Dis 8:785–789CrossRefPubMed

Shafik A, El-Sibai O, Shafik AA, Ahmed I (2003) On the pathogenesis of rectocele: the concept of the rectovaginal pressure gradient. Int Urogynecol J 14:310–315CrossRef

10.

Corman ML, Carriero A, Hager T et al (2006) Consensus conference on the stapled transanal rectal resection (STARR) for disordered defecation. Colorectal Dis 8:98–101CrossRefPubMed

11.

Altomare DF, Spazzafumo L, Rinaldi M, Dodi G, Ghiselli R, Piloni V (2007) Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome. Colorectal Dis 10:84–88PubMed

12.

Pescatori M, Anastasio G, Bottini C, Mentasti A (1992) New grading and scaling for anal incontinence. Dis Colon Rectum 5:482–487CrossRef

13.

Schwandner O, Fürst A (2010) Assessing the safety, effectiveness, and quality of life after the STARR procedure for obstructed defecation: results of the German STARR registry. Langenbecks Arch Surg 395:505–513CrossRefPubMed

14.

Marquis P, De La Loge C, Dubois D, McDermott A, Chassany O (2005) Development and validation of the patient assessment of constipation quality of life questionnaire. Scand J Gastroenterol 40:540–551CrossRefPubMed

15.

Reboa G, Gipponi M, Ligorio M, Marino P, Lntieri F (2009) The impact of transanal rectal resection on anorectal function in patients with obstructed defecation syndrome. Dis Colon Rectum 52:1598–1604CrossRefPubMed

16.

17.

Shafik A, El-Sibai O, Shafik AA, Ahmed I (2003) On the pathogenesis of rectocele: the concept of the rectovaginal pressure gradient. Int Urogynecol J 14:310–315CrossRef

18.

Longo A (2004) Obstructed defecation because of rectal pathologies. Novel surgical treatment: stapled transanal rectal resection (STARR). Annual Cleveland Clinic Florida colorectal disease symposium

19.

Pescatori M, Gagliardi G (2008) Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Tech Coloproctol 12:7–19CrossRefPubMedPubMedCentral

20.

Gagliardi G, Pescatori M, Altomare DF et al (2008) Results, outcome predictors, and complications after stapled transanal rectal resection for obstructed defecation. Dis Colon Rectum 51:186–195CrossRefPubMed

21.

Boenicke L, Reibetanz J, Kim M, Schlegel N, Germer CT, Isbert C (2012) Predictive factors for postoperative constipation and continence after stapled transanal rectal resection. Br J Surg 99:416–422CrossRefPubMed

22.

Goede AC, Glancy D, Carter H, Mills A, Mabey K, Dixon AR (2011) Medium-term results of stapled transanal rectal resection (STARR) for obstructed defecation and symptomatic rectal-anal intussusception. Colorectal Dis 13:1052–1057CrossRefPubMed

23.

D’Avolio M, Ferrara A, Chimenti C (2005) Transanal rectocele repair using EndoGIA: short-term results of a prospective study. Tech Coloproctol 9:108–114CrossRefPubMed

24.

Pescatori M, Zbar AP (2009) Reinterventions after complicated or failed STARR procedure. Int J Colorectal Dis 24:87–95CrossRefPubMed

Title: Rectocele repair with stapled transvaginal rectal resection
Authors: A. A. Shafik
O. El Sibai
I. A. Shafik
Publication date: 01-04-2016
Publisher: Springer Milan
Published in: Techniques in Coloproctology / Issue 4/2016
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-015-1410-6

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Rectocele repair with stapled transvaginal rectal resection

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2016

Validity and reliability of a Lithuanian version of low anterior resection syndrome score

Diagnosis of Lynch syndrome before colorectal resection: does it matter?

Author’s reply to the letter of Doll et al.

Why diverticulosis haunts the Western world

Super-slim endoscopy, in a patient with a Crohn’s ileocecal valve stricture, for assessment of mucosal healing

Pilonidal sinus disease guidelines: a minefield?