Higher symptom score, larger residual rectocele, and lower rectal compliance predict failure of improvement after surgical treatment of rectocele

Background: Rectocele is a frequent finding in women and is usually asymptomatic. However, it is sometimes associated with symptoms of obstructed defecation syndrome (ODS). While most patients with ODS due to rectocele respond well to conservative treatment, some may require surgical treatment. The aim of the study was to determine the predictors of failure of symptom improvement after rectocele repair. Methods: The study included adult women with rectocele who underwent surgical treatment by transperineal repair (TPR) or transvaginal repair (TVR). The preoperative and postoperative assessment was done using the Wexner constipation score, anorectal manometry, and defecography. Results: A total of 93 female patients with a mean age of 43.7 years were included. Among them, 65.6% of patients underwent TPR and 34.4% underwent TVR; 22 (23.7%) patients reported failure of significant improvement in ODS symptoms after surgery. The independent predictors of failure of improvement were higher preoperative Wexner score (odds ratio, OR: 1.4, 95% confidence interval, CI: 1.09-1.84, p = 0.009), larger residual rectocele after repair (OR: 2.95, 95% CI: 1.43-6.08, p = 0.003), and lower postoperative maximum tolerable volume (OR: 0.949, 95% CI: 0.907-0.992, p = 0.02). The predictive cutoff point for the preoperative Wexner score was 15. Conclusions: Patients with a preoperative Wexner score higher than 15 and larger residual rectocele after surgery may experience little improvement in symptoms after rectocele repair. Although TPR was associated with a poorer relief of symptoms than did TVR; it was not an independent predictor of failure. (AU)

Resección rectal por vía perineal mediante engrapadora lineal: experiencia inicial de una nueva técnica para el tratamiento del rectocele anterior / Rectal resection perineally via a linear stapler: initial experience of a new technique for the treatment of the anterior rectocele

Introducción: Analizar los resultados a corto y mediano plazo del tratamiento del rectocele anterior mediante la resección rectal transperineal con engrapadora lineal y refuerzo del tabique rectovaginal con malla. Prospectivo de casos consecutivos. Pacientes y método: Entre 01 de abril de 2008 y 31 de Marzo de 2010, 12 pacientes fueron tratados en nuestra institución por presentar diagnóstico de Rectocele Anterior. Los pacientes fueron evaluados por cirujanos entrenados; sometidos a manometría anorrectal y estudios imagenológicos dinámicos. Se realizó una técnica de Resección Rectal por vía perineal con engrapadora lineal y la aplicación de malla. Se aplicaron distintos scores para evaluar los resultados. Resultados: El 100% fueron sexo femenino, edad promedio 44,6 años. El tiempo promedio de cirugía fue 164 minutos (r: 135-180). No hubo complicaciones intraoperatorias. La estadía media hospitalaria fue 2,6 días. La morbilidad fue del 16,6% (2) y no hubo mortalidad relacionada al procedimiento. La evaluación basal del score ODS mostró un promedio de 19.16, mientras el promedio determinado al 7 y 21 día postoperatorio fue 0,5 y 0,16 respectivamente (P = 0,001). La evaluación del estreñimiento usando el score PAC-SYM mostró un resultado basal promedio de 17,08, mientras que al 7 y 21 día postoperatorio fue 3,25 y 1,32 respectivamente (P = 0,002). El cuestionario de Satisfacción a los 6 meses mostró mejoría significativa respecto al valor basal (p = 0,001). Conclusión: Esta nueva técnica permite restaurar el tabique rectovaginal resecando el defecto rectal. Los resultados funcionales obtenidos son favorables, con baja morbilidad y pocas complicaciones relacionadas al uso de mallas. (AU)

Objective: To analyze short and mid-term results of anterior rectocele treatment by trans perineal rectal resection with linear stapler and rectovaginal septum reinforcement with mesh. Patients and methods: Between 01April 2008 and 31 March 2010, 12 patients were treated at our institution with diagnosis of Anterior Rectocele. Patients were evaluated by trained surgeons, underwent anorectal manometry and dynamic images studies. We performed a novel technique called "Stapled Perineal Rectocele resection". Different scores were applied to evaluate the results. Results: 100% were female, average age 44.6 years. The mean surgical time was 164 minutes (r: 135-180). There were no intraoperative complications. The average hospital stay was 2.6 days. The morbidity was 16.6% (2) and there was no procedure-related mortality. Baseline of ODS showed an average score of 19.16, while the average determined at 7 and 21 days postoperatively was 0.5 and 0.16 respectively (P = 0.001). The assessment of constipation using the PAC-SYM score showed a mean baseline of 17.08 results, while at 7 and 21 days after surgery was 3.25 and 1.32 respectively (P = 0.002). The patient satisfaction score after six months showed significant improvement from baseline (p = 0.001). Conclusion: The novel technique restores rectovaginal septum and extirpates the rectal defect. The functional results are favorable, with low morbidity and few complications related to the use of mesh. (AU)

Mechanical technology effect in the treatment of anorectocele using transanal repair of rectocele and full rectal mucosectomy with one circular stapler procedure / Efeito mecânico da tecnologia no tratamento da anorretocele com o uso do procedimento TRREMS

ABSTRACT Objective: Transanal repair of rectocele and full rectal mucosectomy with one circular stapler is a procedure designed for the treatment of Obstructive Defecation Syndrome by doctor Fco. Sergio Regadas in 2005. We compare the use of multiple instruments and their mechanical technology effect in the treatment of anorectocele. Patients and methods: Female patients complaining about sensation of incomplete evacuation, ages between 40 and 55. The evaluation was made with the function of evacuation protocol: colonic transit time, colon radiology, ecodefecography, anorectal manometry and psychological test. The technique used was transanal repair of rectocele and full rectal mucosectomy with one circular stapler, using staplers CPH-34, CPH-34HV and EEA-3135-HEM, with measurement of the rectal wall resected: vertical length in centimetres, horizontal length in centimetres, weight in grams and volume in cubic centimetres; afterwards histological study of the tissue thickness, and applied the ANOVA and SPSS 12 tests for the statistical analysis. Results: The results obtained by comparing the resections made with the CPH-34, the CPH-34HV and the EEA-3135-HEM in respect of vertical length, horizontal length, weight and volume, were found to have no significant differences; neither in the histological study of the tissue thickness in respect of characteristics and structure. Conclusion: The effect of mechanical technology in the treatment of anorectocele with transanal repair of rectocele and full rectal mucosectomy with one circular stapler procedure using the CPH-34, the CPH-34HV and the EEA-3135-HEM, does not show any difference. Leaving the application of each to the operator competencies.

RESUMO Objetivo: TRREMS (Transanal Repair of Rectocele and full rectal Mucosectomy with one circular Stapler, Reparo transanal de retocele e mucosectomia retal total com um grampo circular) é um procedimento que visa o tratamento da Síndrome da Defecação Obstrutiva pelo Dr. Francisco Sergio Regadas em 2005. Comparamos o uso de diversos instrumentos e o efeito mecânico da tecnologia no tratamento da anorretocele. Pacientes e métodos: Pacientes do gênero feminino com queixa de sensação de evacuação incompleta (SEI), com idades entre 40 e 55 anos. A avaliação foi efetuada com o protocolo de função de evacuação: tempo de trânsito colônico, radiologia do cólon, ecodefecografia, manometria anorretal e teste psicológico. A técnica empregada foi TRREMS, com o uso de grampeadores CPH-34, CPH-34HV e EEA-3135-HEM, com medição da parede retal ressecada: comprimento vertical em centímetros, comprimento horizontal em centímetros, peso em gramas e volume em centímetros cúbicos; subsequentemente, foi realizado estudo histológico da espessura do tecido, com aplicação de ANOVA e do programa SPSS 12 para a análise estatística. Resultados: Observamos que os resultados obtidos com a comparação das ressecções realizadas com CPH-34, CPH-34HV e EEA-3135-HEM com relação ao comprimento vertical, comprimento horizontal, peso e volume, bem como os resultados do estudo histológico da espessura do tecido com relação às características e estrutura, não apresentavam diferenças significativas.

TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler): a prospective multicenter trial / Procedimento TRREMS (reparo transanal de retocele e mucosectomia retal com um grampeador circular): estudo multicêntrico prospectivo

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 percent) and grade 3 (73.3 percent) anorectocele associated with mucosa prolapse and/or rectal intussusception (52.0 percent) 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 percent) patients, bleeding from the stapled line required hemostatic suture. Stapling was incomplete in 2 (2.6 percent). Forty-nine patients (65.3 percent) required 1 hospitalization day, the remainder (34.7 percent) 2 days. Postoperatively, 3 (4.0 percent) patients complained of persistent rectal pain and 7 (9.3 percent) 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 percent). 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.

CONTEXTO: Como a anoretocele está sempre associada a prolapso mucoso e/ou intussuscepção retal, foi desenvolvida uma técnica cirúrgica grampeada, utilizando somente um grampeador mecânico. OBJETIVO: Demonstrar os resultados do estudo multicêntrico que realizou o tratamento cirúrgico de pacientes com anorretocele associado a prolapso mucoso, utilizando o reparo transanal da retocele e mucosectomia com grampeador circular mecânico. MÉTODO: Foram incluídos 75 pacientes, média de idade 49,6 anos, com sintomas de evacuação obstruída, apresentando escore médio de constipação de Wexner de 16 e diagnóstico de anorretocele grau II (26.7 por cento), grau III (73,3 por cento) associado a prolapso mucoso e intussuscepção (52 por cento). Todos foram avaliados com exame proctológico, defecografia, manometria anorretal e tempo de trânsito colônico. O procedimento cirúrgico foi realizado por 14 cirurgiões e consiste na remoção manual da parede do reto no local da retocele e mucosectomia circunferencial com um grampeador circular mecânico. O seguimento médio foi de 21 meses. RESULTADOS: Os pacientes apresentavam sintomas de evacuação obstruída, mesmo após tratamento clinico. O tempo operatório médio foi de 42 minutos. Houve sangramento transanal na linha de sutura em 13 (17,3 por cento) pacientes, sutura grampeada incompleta em 2 (2,6 por cento) e dor retal persistente em 3 (4,0 por cento). O tempo médio de internação hospitalar foi de 1 dia em 49 (65,3 por cento) e 2 dias em 34,7 por cento. Ocorreu redução na linha de sutura em 7 (9,3 por cento), sendo necessário estricturotomia cirúrgica sob anestesia (n = 1), utilizando "hot biopsy" (n = 3) e dilatação anal (3). Defecografia no pós-operatório demonstrou anorretocele residual grau I em 8 (10.6 por cento). O escore de constipação de Wexner reduziu 16 para 4 (0-4: n = 68) (6: n = 6) (7: n = 1) (P<0.0001). CONCLUSÃO: O resultado do estudo multicêntrico demonstrou que a técnica cirúrgica apresentada é segura e efetiva para tratamento da anorretocele associada a prolapso mucoso. Apresenta baixo custo pois utiliza um grampeador circular mecânico.

Tratamiento del síndrome de defecación obstruida mediante la técnica de STARR (Stapled Trans Anal Rectal Resection) / Treatment of obstructed defecation syndrome with STARR technique (Stapled Trans and Rectal Resection)

Antecedentes: El síndrome de defecación obstruida (SDO) es una compleja disfunción del piso pelviano en relación a la evacuación rectal cuyo síntoma principal es la constipación. El rectocele anterior y la intususcepción recto anal son sus alteraciones anatómicas más frecuentes. La técnica de STARR (Stapled Tran Anal Rectal Resection), que implica la resección completa de la pared rectal (anterior y/o posterior) vía transanal mediante la utilización de suturadores circulares de 33 mm, ha surgido como alternativa de tratamiento simultáneo de ambas afecciones. Objetivo: Evaluar los resultados de una técnica quirúrgica, STARR, para el tratamiento del SDO. Diseño: Prospectivo no randomizado. Población: Pacientes del sexo femenino con un índice de SDO superior a 12 sobre 37 puntos posibles. Material y Métodos: Desde Julio de 2007 a Septiembre de 2008 hemos implementado esta técnica en 24 pacientes, seis de las cuales recibieron tratamientos combinados uroginecológicos. Un cuestionario (modificado del índice ODSSS de la Sociedad Italiana de Cirugía de Colon y Recto) para evaluar el índice de defecación obstruida fue respondido por cada paciente. Este índice incluye una evaluación de calidad de vida en base a una escala visual analógica. El mismo se utilizó para evaluar los resultados post operatorios a partir de la cuarta semana...

Background: The obstructive defecation syndrome (ODS) is a complex pelvic floor dysfunction wich implies the difficulty of evacuating the rectum and generates a symptom which is costipation. The presences of an anterior rectocele and/or a recto anal intussusception are the most frequent anatomic findings. The STARR (Starpled Trans Anal Rectal Resection) technique implies a trans anal resection of a strip of anterior and/or posterior rectal wall by means of the use of one or two kits of a 33 mm circular stapler gun. Aim: Evaluate the results of a surgical technique, STARR, for the treatment of ODS. Design: Non randomized prospective study. Population: Female patients with and ODS score >= 12 over possible 37 points. Material and Methods: Since June 2007 up to September 2008 we have applied the STARR procedure to 24 patients, six of whom received a combined uro-gynecological treatment for anterior and/or mid compartment displacements. A modified questionnaire from the Italian Society of Colon and Rectal Surgery was used in order to evaluate the ODS score and quality of life impact. This questionnaire was answered pre surgery and after the fourth week of surgery...

Cura de rectocele por vía transanal: experiencia de la unidad de coloproctología del Hospital Universitario de Caracas / Transanal approach in the treatment of rectocele: experience of the coloproctology unit at the Hospital Universitario of Caracas

Determinar la eficacia de la técnica para cura del rectocele por vía transanal usando la máquina PPH®. Estudio realizado en la Unidad de Coloprotología del Hospital Universitario de Caracas. Estudio prospectivo, descriptivo, realizado entre mayo de 2007 y abril de 2009, cuya población estuvo conformada por 62 mujeres con diagnóstico de rectocele, que presentaban sintomatología importante de síndrome de defecación obstruida (SDO), a las cuales se realizó de estreñimiento tiempo de tránsito colónico (TTC), ciego móvil y defecografía. Fueron intervenidas 20 pacientes haciendo uso de la técnica vía transanal con máquina autosuturadora de 33 mm (PPH). El rectocele grado II ocupó el 77% de los casos. El principal motivo de consulta fue la sensación de evacuación incompleta 74% seguida de la digitalización con 41% ambos síntomas del síndrome de defecación obstruida. Entre las patologías asociadas se encuentran principalmente: hemorroides (59,3%), cistocele (46%), intususcepción o prolapso mucoso (49%). Todos los pacientes intervenidos fueron corregidos por técnica vía transanal haciendo uso de la máquina de PPH 33 mm, de los cuales a 40% se le realizó adicionalmente cura del tiempo posterior, 20% cecopexia y a 5% fistulotomía. El 59% de las pacientes presentó mejoría de los síntomas de defecación obstruida antes de los siete días del postoperatorio, y el resto entre 7 y 15 días. El 45% presentó dolor que cedió con AINES, 25% tuvo urgencia defecatoria y una paciente (5%) presentó estenosis anal resuelta posteriormente. Se demostró que la técnica para cura de rectocele por vía transanal con máquina PPH, tiene una tasa de éxito con resultados satisfactorios de un 95%, con complicaciones menores.

To determinate the efficient of the transanal approach technique to cure rectocele using the PPH machine. Study performed in the Coloproctology Unit at the Hospital Universitario of Caracas. A prospective, descriptive, study carried out on 62 women with rectocele and symptoms of outiet obstruction syndrome (OOS), betwen may 2007 and april 2009. Colonic transit time (CTT), move cecum and defecografy was to each patient. Of these 62 patients, 20 were operated on using the transanal approach technique with the PPH machine and we determited the efficient of that. Of these 62 patients studied, rectocele grade II occupied 77%, the mean symptom was incomplete evacuated sensation (74%), following of digitalization (41%) both symptoms of OOS. We found other pathologies associated like hemorrhoids (59,3%), cistocele (46%), intususcepción or mucosal prolapse (49%). In all the patients operated we used the transanal approach with PPH machine 33 mm; of these patients, 40% we did posterior time cure. 20% cecopexy and 5% fistulotomy. A 59% improved the symptoms of OOS before 7 days and 41% between 7 and 15 days. A 45% of the patients had pain that relieved with AINES, 25% defecatory urgency and one patient stricture that was cure after. We demostrated that the transanal approach technique for rectocele using the PPH machine had low percentage of complications and good results.

Transvaginal mesh repair of the anterior and posterior compartments

The objective of the study is to determine and assess the efficacy and safety of a new technique using a polypropylene mesh [allograft] as an overlap graft for repair of anterior and posterior vaginal wall due to endopelvic fascia defect namely, vesicovaginal and rectovaginal fascia with and without urinary stress incontinence. Pelvic prolapse occurs in more than 20% of Libyan women. 50 patients with vaginal wall prolapse operated in Zawia teaching hospital, Elzahra general hospital, El-Zahrawy clinic and some other hospitals over 4 years [July 2003-June 2007] using polypropylene mesh. 16% with cystocele, 10% with rectocele, combined cystorectocele in 34% and remaining [40%] with other vaginal operations, 94% were above 50 years old. Success rate using Mesh is more than 95%,with very complications. Mesh simplifies the operation, reduces operation time, improves operation quality and reduces recurrence rate

Posterior repair with perforated porcine dermal graft

OBJECTIVE: To compare postoperative vaginal incision separation and healing in patients undergoing posterior repair with perforated porcine dermal grafts with those that received grafts without perforations. Secondarily, the tensile properties of the perforated and non-perforated grafts were measured and compared. MATERIALS AND METHODS: This was a non-randomized retrospective cohort analysis of women with stage II or greater rectoceles who underwent posterior repair with perforated and non-perforated porcine dermal grafts (PelvicolTM CR Bard Covington, GA USA). The incidence of postoperative vaginal incision separation (dehiscence) was compared. A secondary analysis to assess graft tensile strength, suture pull out strength, and flexibility after perforation was performed using standard test method TM 0133 and ASTM bending and resistance protocols. RESULTS: Seventeen percent of patients (21/127) who received grafts without perforations developed vaginal incision dehiscence compared to 7 percent (5/71) of patients who received perforated grafts (p = 0.078). Four patients with vaginal incision dehiscence with non-perforated grafts required surgical revision to facilitate healing. Neither tensile strength or suture pull out strength were significantly different between perforated and non-perforated grafts (p = 0.81, p = 0.29, respectively). There was no difference in the flexibility of the two grafts (p = 0.20). CONCLUSION: Perforated porcine dermal grafts retain their tensile properties and are associated with fewer vaginal incision dehiscences.

Trans-perineal VS. trans-rectal repair of rectocele in obstructed defecation: a prospective randomized trial

To evaluate functional outcome of transperineal [TP] versus transrectal [TR] repair of rectocele presented with obstructed defecation. 48 multiparous females with obstructed defecation due to rectocele were randomly allocated into 3 groups: Group A [16 patients]: TP repair with levatorplasty [LP].Group B [16]: TP repair without LP.Group C [16]: TR repair. The study included defecographic assessment, anal manometry / /[Maximum anal resting pressure [MARP], maximum reflex volume [MRV] and urge to defecate volume [UTDV] and functional score [0 -26]. These were done preoperative and 6 months postoperative. Defecography showed significant reduction in size of rectocele in all groups. Constipation improved significantly in the groups of transperineal but not in transrectal repair. We had significant reduction in MARP, UTDV and MRV only in transperineal approach. Functional score was significantly improved in group A [P<0.001] and B [P<0.001] while the improvement was insignificant in group C. LP significantly improved the overall functional score in group A compared to group B and C [P= 0.032] Rectocele repair improves anorectal function by improving the rectal urge sensitivity. TP repair of rectocele is superior to TR repair in both the structural and functional outcome. Levatorplasty improves functional outcome, but should be avoided in young sexually active females

Defeitos do compartimento vaginal posterior: fisiopatologia e tratamento da retocele / Defects of vaginal posterior compartment: pathophysiology and treatment of rectocele

A retocele é definida como uma herniação da parede anterior do reto e posterior da vagina em direção ao lúmen vaginal. A etiologia da retocele é variada, e como tal, o tratamento deve ser sítio específico. Apenas a miorrafia dos elevadores pode não resolver o problema e comprometer a evacuação, bem como dificultar o acesso ao sítio específico do defeito em futuras intervenções cirúrgicas. O uso de telas sintéticas, especialmente as de polipropileno, se mostra como um recurso valioso nas mulheres que apresentam o septo retovaginal muito atrófico ou com lesão extensa, que impossibilita sua reconstituição.

Tension free monofilament macropore polypropylene mesh (Gynemesh PS) in female genital prolapse repair

OBJECTIVES: To review intraoperative and postoperative complications associated to the correction of cystocele and rectocele with polypropylene mesh macropore monofilament (Gynemesh PS) using transvaginal free tension technique. MATERIALS AND METHODS: Prospective study of patients that have been submitted to correction of cystocele and/or rectocele between November 2004 and August 2005 in the Urogynecology and Vaginal Surgery Unit of Gynecology and Obstetrics Department, Las Condes Clinic. Mesh was used in 31 patients: 9 for cystocele, 11 for rectocele, and 11 for concomitant meshes. Total mesh used 42. Media age 55 years old, weight 64 kilograms. In 7 patients we used a third mesh for correction of urinary incontinence by TVT-O technique. RESULTS: They did not present intraoperative complications, neither in immediate or delayed postoperative time. We did not observe hematoma, infection, erosion or exposition mesh. Healing of cystocele and rectocele was obtained in 100 percent of patients, with a pursuit between 1 and 8 months. DISCUSSION: The use of prosthetic polypropylene monofilament macropore mesh in the correction of cystocele and/or rectocele, by transvaginal route with tension free technique seems to be a safe and effective surgery procedure.

Corrección de rectocele con IVS posterior y malla tunelizada por el tabique rectovaginal / Rectocele repair with posterior intravaginal slingplasty

Presentamos 50 pacientes portadoras de prolapso genital posterior sometidas a reparación con malla de prolene tunelizada y aplicación de cinta de prolene transelevador como profilaxis del prolapso de pared vaginal posterior, ingresadas al servicio de Ginecología del Hospital Carlos Van Buren entre Diciembre de 2004 y Febrero de 2006. El diagnóstico preoperatorio fue prolapso genital completo en 38 mujeres, prolapso de pared vaginal anterior y posterior en 8, prolapso de cúpula en 3 y prolapso de pared vaginal posterior en una. En 30 pacientes se asoció además incontinencia urinaria de esfuerzo. 92 por ciento de las pacientes evolucionan en forma satisfactoria en el seguimiento intra y postoperatorio con restauración de la anatomía del piso pelviano y sin complicaciones mayores. Creemos que es necesario un seguimiento mayor para validar en forma definitiva esta técnica, aún cuando en nuestro estudio este procedimiento resulta superior al que utiliza el puente mucoso para reparar la pared posterior.

Correção cirúrgica endo anal da retocele importância do anismus / Surgical corection endo anal of the rectocele importance of the anismus

A retocele é frequentemente associada a sintomas ano-retais, sendo que várias técnicas são descritas para a sua correção. O presente estudo avalia os resultados funcionais do reparo trans anal da retocele, com particular ênfase para a existência pré operatória do Anismus. 50 pacientes do sexo feminino que foram submetidas ao reparo transanal de Retocele, por Defecação Obstruída, foram revistas. Todas as pacientes eram multíparas com paridade variando entre 2 a 6 partos, sendo a média de 3. A idade das pacientes variou entre 28 a 50 anos, com média de 42 anos e o tempo médio de seguimento foi de 12 meses. O Anismus foi detectado através da história clínica e exames de fisiologia ano retal, em 14 pacientes ( 28por cento ). Os resultados funcionais foram avaliados através de questionário padrão, exame físico e testes de fisiologia ano retal. Concluímos que os resultados funcionais do Reparo Transanal da Retocele foram melhores nas pacientes sem Anismus, tratando-se de uma cirurgia segura e que, na ausência de Contração Paradoxal do Assoalho Pélvico, efetivamente corrige a Defecação Obstruída.

Rectocele anterior / Anterior rectocele

Antecedentes: La aparición de los procedimientos de evaluación de la fisiología colo-recto-anal ha permitido a los cirujanos colorrectales, diagnosticar y tratar esta afección (motivo de constipación y dificultad evacuatoria) con mayor asiduidad. Objetivo: Presentar una alternativa de tratamiento quirúrgico mediante el abordaje transperineal. Diseño: Se procedió a tratar quirúrgicamente a las pacientes que se ajustaban al criterio de selección. La evaluación de los resultados del tratamiento mediante exámen físico, interrogatorio y defecatografía de control a los 4 meses del postoperatorio. Población: Se evalúa una población de 79 pacientes constipados crónicos mediante defecatografía, de estos, 50 eran portadores de rectocele anterior y solo 37 fueron operados por ajustarse a los criterios de selección. Todos los pacientes fueron del sexo femenino. con una media de edad de 48 años (20-73). Método: Se trataron quirúrgicamente 35 pacientes mediante un abordaje transperineal, con rectocele anterior de un diámetro medio de 5 ñ 1.01 cm (4 - 8.5 cm). El seguimiento postoperatorio fue de 40 ñ 21 (1-80) meses. Resultados: Excelentes/buenos en el 97.2 por ciento de los pacientes. Hubo un paciente (2.8 por ciento) que presentó una fístula recto-vaginal, que fue tratada con un deslizamiento de colgajo miomucoso, por vía transrectal.

Tratamento cirúrgico da retocele / Surgical treatment of rectocele

Apresentam os autores os resultados obtidos no tratamento cirúrgico da retocele empregados em 65 pacientes com sintomatologia importante. A técnica utilizada foi a correçäo por via endoanal descrita por Sullivan, modificada. Todos os pacientes foram avaliados pré-operatoriamente através de protocolo rígido para constipaçäo utilizado no nosso serviço. Sensaçäo de evacuaçäo incompleta, straining, e digitaçäo foram os achados clínicos mais frequentes (85 porcento). Cinquenta e nove pacientes (90,7 porcento) encontram-se assintomáticos após 27 meses de acompanhamento