Transanal repair of rectocele and full rectal mucosectomy with one circular stapler: a novel surgical technique

2005 ◽  
Vol 9 (1) ◽  
pp. 63-66 ◽  
Author(s):  
F. S. P. Regadas ◽  
S. M. M. Regadas ◽  
L. V. Rodrigues ◽  
R. Misici ◽  
F. R. Silva ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Circular Stapler ◽  
Transanal Repair ◽  
Rectal Mucosectomy

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

2011 ◽  
Vol 48 (1) ◽  
pp. 3-7 ◽  
Author(s):  
José Vinicius Cruz ◽  
Francisco Sergio P. Regadas ◽  
Sthela Maria Murad-Regadas ◽  
Lusmar Veras Rodrigues ◽  
Fernando Benicio ◽  
...  
Keyword(s):  
Obstructed Defecation ◽  
Circular Stapler ◽  
Multicenter Trial ◽  
Colonic Transit ◽  
Rectal Intussusception ◽  
Rectal Pain ◽  
Transanal Repair ◽  
Rectal Mucosectomy ◽  
The Mean ◽  
Prospective Multicenter Trial

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.

scholarly journals Stapled Transanal Rectal Resection for the Surgical Treatment of Obstructed Defecation Syndrome Associated with Rectocele and Rectal Intussusception

ISRN Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Hesham M. Hasan ◽  
Hani M. Hasan
Keyword(s):  
Surgical Technique ◽  
Rectal Resection ◽  
Obstructed Defecation ◽  
Circular Stapler ◽  
Rectal Intussusception ◽  
Prospective Clinical Study ◽  
Safe Procedure ◽  
Stapled Transanal Rectal Resection ◽  
Obstructed Defecation Syndrome

Obstructed defecation syndrome (ODS) is one of the most widespread clinical problems which frequently affects middle-aged females. There is a new surgical technique called stapled transanal rectal resection (STARR) that makes it possible to remove the anorectal mucosa circumferential and reinforce the anterior anorectal junction wall with the use of a circular stapler. This surgical technique developed by Antonio Longo was proposed as an effective alternative for the treatment of ODS. In this study we present our preliminary results with the STARR operation for the treatment of ODS. For this purpose, 40 consecutive female patients with ODS due to rectal intussusception (RI) and/or rectocele (RE) were recruited in this prospective clinical study, from May 2008 to October 2010. No major operative or postoperative complications were recorded, and after 12-month follow-up, significant improvement in the ODS score system was observed, and the symptoms of constipation improved in 90% of patients; 20% of patients judged their final clinical outcome as excellent, 55% as good, and 15% as moderate, with only 10% having poor results. After analyzing our results we can conclude that STARR is an effective and safe procedure for the treatment of obstructed defecation syndrome due to rectal intussusception and/or rectocele and can be performed safely without major morbidity.

scholarly journals Variation in esophageal anastomosis technique—the role of collaborative learning

2019 ◽  
Vol 33 (5) ◽  
Author(s):  
L J Halliday ◽  
S L F Doran ◽  
B Sgromo ◽  
Y K S Viswanath ◽  
O Tucker ◽  
...  
Keyword(s):  
Collaborative Learning ◽  
Surgical Technique ◽  
Operative Technique ◽  
Circular Stapler ◽  
Gastric Conduit ◽  
Transfer Of Knowledge ◽  
Multiple Dimensions ◽  
Improved Outcomes ◽  
Optimum Diameter ◽  
Esophageal Anastomosis

SUMMARY Centralization of care has improved outcomes in esophagogastric (EG) cancer surgery. However, specialist surgical centers often work within clinical silos, with little transfer of knowledge and experience. Although variation exists in multiple dimensions of perioperative care, the differences in operative technique are rarely studied. An esophageal anastomosis workshop was held to identify areas of common and differing practice within the operative technique. Surgeons showed videos of their anastomosis technique by open and minimally invasive surgery. Each video was followed by a discussion. Surgeons from 10 different EG cancer centers attended. Eight key technical differences and learning points were identified and discussed: the optimum diameter of the gastric conduit; avoiding ischemia in the gastric conduit; minimizing esophageal trauma; the use of an esophageal mucosal collar; omental wrapping; intraoperative leak testing; ideal diameter of the circular stapler and the growing use of linear stapled anastomoses. The workshop received positive feedback from participants and on 2 years follow-up, 40% stated that they believed that the learning of tips and techniques during the workshop has contributed to lowering their anastomotic leak rate. Many differences exist in surgical technique. The reasons for, and crucially the significance of, these differences must be discussed and examined. Workshops provide a forum for peer-to-peer collaborative learning to reflect on one’s own practice and improve surgical technique. These changes can, in turn, generate incremental improvements in patient care and postoperative outcomes.

1690: Orthotopic Renal Transplant: An Alternative Surgical Technique in Selected Cases

2006 ◽  
Vol 175 (4S) ◽  
pp. 544-544
Author(s):  
Mireia Musquera ◽  
Anna Agud ◽  
Lluis Peri ◽  
Maria Jose Ribal ◽  
Federico Oppenheimer ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Surgical Technique
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