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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2010 October;23(5):167-72
Combined approach for correction of symptomatic rectocele and associated rectal intussusception
Gentile M., De Rosa M., Carbone G., Mosella F., Forestieri P.
Department of General, Oncological and Videoassisted Surgery, University of Naples “Federico II”, Naples, Italy
Aim. Rectocele is a frequent asimptomatic finding occurring quite exclusively in women. It can be often associated with a mucosal prolapse or recto-anal intussusception producing the so called “outlet obstruction”. Many approaches are reported with different functional results in order to correct such a defect including transvaginal, transanal, transabdominal and combined techniques and more recently the use of graft materials has been introduced by gynaecologists to reinforce the tissue reconstruction. The use of a combined approach in order to correct both the defects (rectocele and ano-rectal prolapse) has been re-evaluated with the use of a circular stapler to perform an anterior mucosectomy through a transanal approach associated with a posterior colpoperineorrhaphy.
Methods. Thirty-six patients suffering from rectocele and associated mucosal prolapse or rectal intussusception underwent single stapler transanal mucosectomy and posterior colpoperineorrhaphy. All patients were female and complained for ano-rectal symptoms of obstructed defecation: they were scheduled by clinical evaluation included Wexner continence score, colpocistodefecography and manometric assessment: The size of rectocele considered was more or equal than 2 cm.
After the operation a complete reassessment was performed at six months with a clinical, radiological and manometric evaluation of the results. Moreover all patients were requested to give a subjective evaluation by a short questionnaire. Another follow-up was performed one year after surgery perfprmed.
All the results were statistically evaluated.
Results. There was a significant improvement of symptoms with a low rate (11%) of persistent incomplete evacuation or perineal heaviness. The need of digitating completely disappeared. There was a little but statistically not significant increase in dyspareunia from 5.5% to 16%. The overall satisfaction grade was very high. A good correspondence between preoperative radiological findings and clinical symptoms was evidenced; in the follow-up colpocistodefecography revealed a persistence of rectocele or mucosal prolapse even in absence of clinical signs of obstructed defecation.
Conclusions. A combined transanal and transvaginal approach is an effective treament for the correction of rectocele and associated anorectal intussusception with obstucted defecation simptoms. It provides good results with a low complications rate. Physiological changes in ano-rectal functions after surgery are poor and the subjective statisfaction grade high. Due to the use of a single staplig device it is also less expensive than other transanal operations.