Objectives: Rectocele and rectal intussusception can lead to mechanical obstruction with difficulty or inability to void formed faeces. Rectocele and intussusception are widespread, often asymptomatic and coexisting with other pelvic alterations like enterocele, hyperdescending perineum and genital prolapsed. The role of each alteration in Obstructed Defecation Syndrome (ODS) is unclear. The Circular Stapled Transanal Rectal Resection (CSTR), removes the prolapsing rectum, frees the rectal lumen and correct intussusception and rectocele. The purpose of this study was to investigate the functional outcome after the CSTR procedure of a group of patients with internal mucosal prolapsed or rectocele causing obstructed defecation using a 31 and/ or 33-mm circular stapler.
Materials and methods: From June 2007 to July 2008, 23 female patients (mean age 53.1, range 36–71) with severe ODS due to rectocele and/or intussusception were evaluated by questionnaire, clinical examination, defecography and anal manometry, were treated by the CSTR procedure and enrolled in a prospective single group clinical trial.
Results: The median operating time was 45 minutes (30–110 minutes). The median hospital stay was 40 hours (11–72 hours). Complications during the first 24 hours were fecal urgency, urinary retention, and rectal bleeding. Pruritus ani, thrombosed external hemorrhoids, rectal bleeding, anal fissure, and persistent skin tags were the symptoms seen during the long-term follow-up. The median follow-up was 6 months (1–10 months). A symptom score—ODS score 0–4 (0: no obstruction, 4: severe obstruction)—was calculated and compared preoperative and postoperative. Patients were asked to judge their postoperative results as “excellent”, “good”, “fair” or “poor”. Correspondingly 84.6% regarded their results as “excellent”.
Conclusions: The CSTR procedure is a useful technique to achieve a markedly improvement of the ODS score in patients suffering from symptomatic intussusception and rectocele.
Program Number: P099