Clinical and functional evaluation of patients with rectocele and mucosal prolapse treated with transanal repair of rectocele and rectal mucosectomy with a single circular stapler (TRREMS)

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.

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Mechanical technology effect in the treatment of anorectocele using transanal repair of rectocele and full rectal mucosectomy with one circular stapler procedure

Journal of Coloproctology ◽

10.1016/j.jcol.2016.12.003 ◽

2017 ◽

Vol 37 (2) ◽

pp. 100-108

Author(s):

Carlos Sardiñas ◽

Dilia Díaz Arreaza ◽

Héctor Osorio

Keyword(s):

Circular Stapler ◽

Transanal Repair ◽

Rectal Mucosectomy

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Doppler-Guided Hemorrhoid Artery Ligation with Recto-Anal-Repair Modification: Functional Evaluation and Safety Assessment of a New Minimally Invasive Method of Treatment of Advanced Hemorrhoidal Disease

The Scientific World JOURNAL ◽

10.1100/2012/324040 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 12

Author(s):

Piotr Walega ◽

Michal Romaniszyn ◽

Jakub Kenig ◽

Roman Herman ◽

Wojciech Nowak

Keyword(s):

Safety Assessment ◽

Mucosal Prolapse ◽

Hemorrhoidal Disease ◽

Functional Evaluation ◽

Artery Ligation ◽

Major Complications ◽

Hemorrhoidal Artery Ligation ◽

Hemorrhoidal Artery ◽

Invasive Method ◽

Grade Iii

Purpose: We present 12-month followup results of functional evaluation and safety assessment of a modification of hemorrhoidal artery ligation (DGHAL) called Recto-Anal-Repair (RAR) in treatment of advanced hemorrhoidal disease (HD).Methods: Patients with grade III and IV HD underwent the RAR procedure (DGHAL combined with restoration of prolapsed hemorrhoids to their anatomical position with longitudinal sutures). Each patient had rectal examination, anorectal manometry, and QoL questionnaire performed before 3 months, and 12 months after RAR procedure.Results: 20 patients completed 12-month followup. There were no major complications. 3 months after RAR, 5 cases of residual mucosal prolapse were detected (25%), while only 3 patients (15%) reported persistence of symptoms. 12 months after RAR, another 3 HD recurrences were detected, to a total of 8 patients (40%) with HD recurrence. Anal pressures after RAR were significantly lower than before (P<0.05), and the effect was persistent 12 months after RAR. One patient (5%) reported occasional soiling 3 months after RAR.Conclusions: RAR seems to be a safe method of treatment of advanced HD with no major complications. The procedure has a significant influence on anal pressures, with no evidence of risk of fecal incontinence after the operation.

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Treatment of external anorectal mucosal prolapse with circular stapler

Diseases of the Colon & Rectum ◽

10.1007/bf02236713 ◽

1999 ◽

Vol 42 (8) ◽

pp. 1102-1105 ◽

Cited By ~ 38

Author(s):

Donato F. Altomare ◽

Marcella Rinaldi ◽

Carmine Chiumarulo ◽

Nicola Palasciano

Keyword(s):

Circular Stapler ◽

Mucosal Prolapse

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A method for the functional evaluation of disability

PsycEXTRA Dataset ◽

10.1037/e534562008-005 ◽

1960 ◽

Author(s):

Norris D. Vestre

Keyword(s):

Functional Evaluation

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Functional Evaluation of Integrated Passenger Transportation Hub Based on Fuzzy Comprehensive Evaluation Method

CICTP 2020 ◽

10.1061/9780784483053.225 ◽

2020 ◽

Author(s):

Jianyou Zhao ◽

Yi Li ◽

Yuntao Ye

Keyword(s):

Evaluation Method ◽

Comprehensive Evaluation ◽

Fuzzy Comprehensive Evaluation ◽

Functional Evaluation ◽

Fuzzy Comprehensive Evaluation Method ◽

Comprehensive Evaluation Method ◽

Passenger Transportation

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Safety And Preliminary Efficacy of Magnetic Stimulation of Pelvic Floor with Hifem Technology in Urinary Incontinence

Medical & Clinical Research ◽

10.33140/mcr.03.02.10 ◽

2018 ◽

Vol 3 (2) ◽

Keyword(s):

Urinary Incontinence ◽

Pelvic Floor ◽

Magnetic Stimulation ◽

Muscle Tone ◽

Pelvic Floor Muscle ◽

Neuromuscular Control ◽

Ultrasound Elastography ◽

Functional Evaluation ◽

Muscle Injuries ◽

Stimulation Of

Introduction: BTL EMSELLA™ utilizes High-Intensity Focused Electromagnetic technology (HIFEM) to cause deep pelvic floor muscles stimulation and restoration of the neuromuscular control. Key effectiveness is based on focused electromagnetic energy, in-depth penetration and stimulation of the entire pelvic floor area. A single BTL EMSELLA™ session brings thousands of supramaximal pelvic floor muscle contractions, which are extremely important in muscle reeducation of incontinent patients. Objective: Prospective study to evaluate the safety and preliminary effectiveness of the use of BTL EMSELLA magnetic stimulation in urinary incontinence. Method: Thirty-two patients with light and moderate urinary incontinence were recruited to perform 6 sessions of BTL EMSELLA during three weeks of initial treatment. Follow-up after three months. The patients received sessions lasting 28 minutes, completing the different treatment protocols. Initially the patients underwent a quality of life test before and after treatment, evaluation with advanced ultrasound using elastography to measure the initial tissue's elasticity and be able to compare after treatment, clinical functional evaluation and urodynamic test. Results: No adverse reactions were observed. All the patients finished the treatment sessions. Two patients reported increased pain after treatment in the first session corresponding to a VAS scale greater than 5 with duration greater than three hours. The treatment was highly satisfactory in 84,4% of the patients. After the first three months the improvement was maintained in 77% of the patients. No muscle injuries were observed. Elastographic changes and improvement of muscle tone were detected by advanced ultrasound (elastography) in 100% of patients. Conclusions: BTL EMSELLA is safe, well tolerated and effective for the treatment of mild and moderate urinary incontinence. The observed elastographic changes demonstrate the improvement of pelvic floor muscle tone after treatment. A reduction in the symptoms of urinary incontinence was demonstrated. Recommendations: Continue increasing the number of cases for research and increase the variables that we have decided to incorporate in the next research section such as MRI and pressure calculation.

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