Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception

AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with rectocele and/or rectal intussusception underwent STARR.The preoperative status,perioperative and postoperative complications at baseline,3,6 and 12-mo were assessed.Data were collected prospectively from standardized questionnaires for the assessment of constipation[constipation scoring system,Longo’s obstructed defecation syndrome(ODS)score system,symptom severity score],patient satisfaction (visual analogue scale),and quality of life(Patient Assessment of Constipation-Quality of Life Questionnaire).RESULTS:At a 12-mo follow-up,significant improvement in the constipation scoring system,ODS score system,symptom severity score,visual analog scale and quality of life(P<0.0001)was observed.The symptoms of constipation improved in 90%of patients at 12 mo after surgery.The self-reported definitive outcome was excellent in 15(30%)patients,fairly good in 8(16%),good in 22(44%),and poor in 5(10%).CONCLUSION:STARR can be performed safely without major morbidity.Moreover,the procedure seems to be effective for patients with obstructed defecation associated with symptomatic rectocele and rectal intussusception.

Application of prostate resectoscope in the treatment of massive rectal bleeding after transrectal prostate puncture

BACKGROUND Ultrasound-guided prostate biopsy is a reliable diagnostic procedure for prostate cancer diagnosis with minimal procedure-related trauma.However,complications,such as massive rectal bleeding may occur after the puncture.We hypothesized that using a transrectal resectoscope could help treat massive rectal bleeding after transrectal prostate punctures.AIM To identify a simple and effective treatment for massive rectal bleeding after transrectal prostate punctures.METHODS Patients requiring treatment for massive rectal bleeding after transrectal prostate punctures were included.A SIMAI resectoscope was inserted through the anus.Direct electrocoagulation was performed for superficial bleeding points.Part of the rectal mucosa or surface muscle layer was removed to expose deep bleeding points,followed by electrocoagulation.An electric cutting ring was used to compress and stop the bleeding for jet-like points before electrocoagulation.The fluid color in the drainage tube was monitored postoperatively for continuous bleeding.RESULTS Eight patients were included from 2012 to 2022.None of the patients with massive rectal bleeding after the transrectal prostate punctures improved with conventional conservative and blood transfusion treatments.Two patients had an inferior artery embolism,and digital subtraction angiography was ineffective.All patients received emergency transanal prostate resection,which immediately stopped the bleeding.Four days after the procedure,the patients had recovered and were discharged.CONCLUSION Using a transanal prostate resection instrument is a simple,safe,and effective method for treating massive rectal bleeding after transrectal prostate punctures.

Use of transanal minimally invasive surgery for endoscopic resection of rectal tumour:a technical note

Background:The aim of this article is to report and discuss a case of lower rectal cancer undergoing endoscopic transanal resection of tumour(ETART)using a transanal minimally invasive surgery(TAMIS)approach.Methods:A technical note on a case report.An innovative approach for ETART using TAMIS.Results:This is the first-ever case report of lower rectal cancer treated by ETART using a TAMIS approach.The procedure was completed successfully without any operative or peri-operative complication.Peri-operative flexible sigmoidoscopy confirmed a wide and patent rectal lumen.Conclusion:Use of a TAMIS approach for ETART to remove lower rectal cancer for palliation can be technically very effective compared with conventional ETART,due to the potential advantages of avoiding contaminant fluid spillage,easy access,better visualization compared with conventional ETART,and being user-friendly.The results from larger cohorts of patients undergoing TAMIS ETART are required before recommending the routine use of this technique.However,until then,this approach may be considered as an alternative to conventional ETART.

Resected specimen evaluation,anorectal manometry,endoanal ultrasonography and clinical follow-up after STARR procedures

AIM:To investigate stapled transanal rectal resection (STARR) procedures as surgical techniques for obstructed defecation syndrome (ODS) by analyzing specimen evaluation,anorectal manometry,endoanal ultrasonography and clinical follow-up.METHODS:From January to December 2007,we have treated 30 patients.Fifteen treated with double PPH-01 staplers and 15 treated using new CCS 30 contour.Resected specimen were measured with respect to average surface and volume.All patients have been evaluated at 24 mo with clinical examination,anorectal manometry and endoanal ultrasonography.RESULTS:Average surface in the CCS 30 group was 54.5 cm2 statistically different when compared to the STARR group (36.92 cm2).The average volume in the CCS 30 group was 29.8 cc,while in the PPH-01 it was23.8 cc and difference was statistically significant.The mean hospital stay in the CCS 30 group was 3.1 d,while in the PPH-01 group the median hospital stay was 3.4 d.As regards the long-term follow-up,an overall satisfactory rate of 83.3% (25/30) was achieved.Endoanal ultrasonography performed 1 year following surgery was considered normal in both of the studied groups.Mean resting pressure was higher than the preoperative value (67.2 mmHg in the STARR group and 65.7 mmHg in the CCS30 group vs 54.7 mmHg and 55.3 mmHg,respectively).Resting and squeezing pressures were lower in those patients not satisfied,but data are not statistically significant.CONCLUSION:The STARR procedure with two PPH-01 is a safe surgical procedure to correct ODS.The new Contour CCS 30 could help to increase the amount of the resected tissue without differences in early complications,post-operative pain and in hospital stay compared to the STARR with two PPH-01 technique.

Prognostic and predictive value of interstitial cells of Cajal populations following stapled transanal rectal resection(STARR)in patients with obstructed defecation syndrome

Objective:The present study was designed to evaluate the functional outcome of stapled transanal rectal resection(STARR)and to examine the relationship between the population density of the interstitial cells of Cajal(ICC)and the efficacy of the STARR operation in the management of obstructed defecation syndrome(ODS)patients.Methods:Full-thickness rectal samples were obtained from 50 ODS patients who underwent STARR.Samples were analysed using ICC immunohistochemistry.Clinical and functional parameters obtained with defecography and anorectal manometry were compared with 20 controls.Results:ICCs were significantly decreased in patients in the submucosal(SM),intramuscular(IM)andmyenteric(MY)regions when compared with the control group(P<0.05).The mean pre-operative Cleveland Constipation Score(CCS)was 24.264.1,whilst the CCS at 1,2,3,4 and 5 years post-operatively decreased significantly(P<0.05).At 3 post-operative years,58.3%(28/48)of the patients reported a favorable outcome(CCS10).On univariate analysis,the functional results were worse in those with pre-operative digitation(P=0.017),a decreased ICC-MY cell population(P=0.067),a higher resting anal canal pressure(P=0.039)and a higher rectal sensory threshold(P=0.073).Multivariate analysis showed the decreased ICC-MY cell population was an independent predictor for low unfavorable functional outcome(odds ratio=0.097,95%confidence interval:0.012–0.766).Conclusions:STARR achieved acceptable results at the cost of a slight deterioration over amore prolonged follow-up.Patients with a decreased ICC number in the rectal specimen showed an unfavorable functional outcome where pre-operative histological assessment of a full-thickness rectal samplemight predict for the functional outcome following STARR.

Outcomes of a modified Bresler procedure for the treatment of rectocele with rectal intussusception

Background:Obstructed defecation syndrome(ODS)is a condition that is frequently caused by rectocele and rectal intussusception.This study aimed to evaluate the effectiveness of a modified Bresler procedure for the treatment of ODS.The outcomes of this modified procedure were compared with the stapled transanal rectal resection(STARR)procedure.Methods:We performed a retrospective analysis of the clinical data from 76 female patients who presented with ODS between June 2014 and June 2016.The patients were divided into two treatment groups,namely Modified and STARR.Patients in the Modified group(n=36)underwent the modified Bresler procedure,which involved posterior rectal-wall resection using a circular tubular stapler with multilevel purse-string sutures.Patients in the STARR group(n=40)underwent the standard STARR procedure.We analysed post-operative complications,Wexner constipation scores(WCS),rectocele depths,and four-point post-operative satisfaction scales.Results:Patients in the Modified group exhibited shorter operative times and fewer post-operative complications(both P<0.05).At 12 months post-operatively,both the Modified and STARR groups displayed a significant improvement in the Wexner constipation score and the depth of rectocele.The post-operative WCS for the Modified group were significantly improved compared to those for the STARR group(P<0.05),while there was no significant difference in the rectocele depth between the two groups(P>0.05).Post-operative interviews at post-operative 12 months showed that patients in the Modified group had a better satisfaction(P=0.05).Conclusions:Our modified procedure may be an effective treatment strategy for patients experiencing ODS caused by rectocele and rectal intussusception,with fewer complications and effective relief of symptoms.