Skip to main content

Advertisement

SpringerLink
Log in

Rectocele repair with stapled transvaginal rectal resection

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

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

    Article  PubMed  Google Scholar 

  2. 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 49:135–142

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  Google Scholar 

  7. 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

    Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  9. 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 14:310–315

    Article  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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 10:84–88

    PubMed  Google Scholar 

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

    Article  Google Scholar 

  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 395:505–513

    Article  PubMed  Google Scholar 

  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 40:540–551

    Article  PubMed  Google Scholar 

  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 52:1598–1604

    Article  PubMed  Google Scholar 

  16. 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. Surg Innov 15:105–109

    Article  PubMed  Google Scholar 

  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 14:310–315

    Article  Google Scholar 

  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 12:7–19

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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 51:186–195

    Article  PubMed  Google Scholar 

  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 99:416–422

    Article  CAS  PubMed  Google Scholar 

  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 13:1052–1057

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine, Cairo University, 7, Gamal Salem St., Off Mossadak St., Dokki, Cairo, Egypt

    A. A. Shafik & I. A. Shafik

  2. Department of Surgery, Faculty of Medicine, Menoufia University, Al Minufiya, Egypt

    O. El Sibai

Authors
  1. A. A. Shafik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. O. El Sibai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I. A. Shafik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. A. Shafik.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Ethics Committee of the Cairo University Coloproctology Department.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shafik, A.A., El Sibai, O. & Shafik, I.A. Rectocele repair with stapled transvaginal rectal resection. Tech Coloproctol 20, 207–214 (2016). https://doi.org/10.1007/s10151-015-1410-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-015-1410-6

Keywords

Search

Navigation