TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler): a prospective multicenter trial

Arquivos de Gastroenterologia

José Vinicius Cruz²  Francisco Sergio P. Regadas¹  Sthela Maria Murad-regadas¹  Lusmar Veras Rodrigues¹  Fernando Benicio¹  Rogério Leal¹  César G. Carvalho¹  Margarete Fernandes¹  Lucimar M. C. Roche¹  Antônio Carlos Miranda¹  Lucia Câmara¹  Joaquim Costa Pereira¹  Antonio Mallén Parra¹  Vilmar Moura Leal¹ 

[1] ,Federal University of Porto Alegre School of MedicineRS

关键词: Rectocele;    surgery;    Intestinal mucosa;    surgery;    Rectal prolapse;    Fecal incontinence;    Surgical stapling;    Retocele;    cirurgia;    Mucosa intestinal;    cirurgia;    Prolapso retal;    Incontinência fecal;    Grampeamento cirúrgico;   

DOI  :  10.1590/S0004-28032011000100002

来源: SciELO

【 摘 要 】

CONTEXT: Since anorectocele is usually associated with mucosa prolapse and/or rectal intussusceptions, it was developed a stapled surgical technique using one circular stapler. OBJECTIVE: To report the results of Transanal Repair of Rectocele and Rectal Mucosectomy with one Circular Stapler (TRREMS procedure) in the treatment of anorectocele with mucosa prolapse in a prospective multicenter trial. METHODS: It was conducted by 14 surgeons and included 75 female patients, mean aged 49.6 years, with symptoms of obstructed defecation due to grade 2 (26.7%) and grade 3 (73.3%) anorectocele associated with mucosa prolapse and/or rectal intussusception (52.0%) and an average validated Wexner constipation score of 16. All patients were evaluated by a proctological examination, cinedefecography, anal manometry and colonic transit time. The TRREMS procedure consists of the manual removal of the rectocele wall with circumferential rectal mucosectomy performed with a circular stapler. The mean follow-up time was 21 months. RESULTS: All patients presented obstructed defecation and they persisted with symptoms despite conservative treatment. The mean operative time was 42 minutes. In 13 (17.3%) patients, bleeding from the stapled line required hemostatic suture. Stapling was incomplete in 2 (2.6%). Forty-nine patients (65.3%) required 1 hospitalization day, the remainder (34.7%) 2 days. Postoperatively, 3 (4.0%) patients complained of persistent rectal pain and 7 (9.3%) developed stricture on the stapled suture subsequently treated by stricturectomy under anesthesia (n = 1), endoscopic stricturectomy with hot biopsy forceps (n = 3) and digital dilatation (n = 3). Postoperative cinedefecography showed residual grade I anorectoceles in 8 (10.6%). The mean Wexner constipation score decreased significantly from 16 to 4 (0-4: n = 68) (6: n = 6) (7: n = 1) (P<0.0001). CONCLUSION: Current trial results suggest that TRREMS procedure is a safe and effective technique for the treatment of anorectocele associated with mucosa prolapse. The stapling technique is low-cost as requires the use of a single circular stapler.

【 授权许可】

CC BY-NC   
 All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License