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

Author:

Cruz José Vinicius1,Regadas Francisco Sergio P.2,Murad-Regadas Sthela Maria2,Rodrigues Lusmar Veras2,Benicio Fernando3,Leal Rogério3,Carvalho César G.4,Fernandes Margarete5,Roche Lucimar M. C.5,Miranda Antônio Carlos6,Câmara Lucia7,Pereira Joaquim Costa8,Parra Antonio Mallén9,Leal Vilmar Moura10

Affiliation:

1. Federal University of Porto Alegre

2. Federal University of Ceará

3. Barão de Lucena Hospital

4. Hospital da Lagoa

5. Hospital do Servidor Público Estadual

6. Piedade Hospital

7. Hospital Policlínica, Brasil

8. Hospital Distrital Macedo de Cavaleiros, Portugal

9. Servicio Ambulatorio Cirugia Avanzada, Venezuela

10. Federal University of Piauí, Brasil

Abstract

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.

Publisher

FapUNIFESP (SciELO)

Subject

Gastroenterology

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