ORIGINAL ARTICLE   

Minerva Chirurgica 2020 April;75(2):83-91

DOI: 10.23736/S0026-4733.20.08175-4

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Early and late effects of the sequential transfixed stich technique for the treatment of the symptomatic rectocele without rectal mucosa prolapse

Fabio GAJ ¹, Ivano BIVIANO ², Antonello TRECCA ³, Quirino LAI ¹ ✉, Jacopo ANDREUCCETTI ⁴

¹ Department of General Surgery and Organ Transplantation, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy; ² Unit of Gastroenterology and Operative Endoscopy, Santa Maria alle Scotte Hospital, Siena, Italy; ³ Unit of Operative Endoscopy, Progetto I-Salus, Rome, Italy; ⁴ Unit of General and Mini-Invasive Surgery, San Camillo Hospital, Trento, Italy

BACKGROUND: Different surgical techniques have been proposed for rectocele repair. However, controversial aspects exist on the best approach to use. The study aims to report the early and late outcomes of the sequential transfixed stich technique (STST) for the treatment of rectocele in the absence of mucosal prolapse.
METHODS: One hundred patients presenting a symptomatic rectocele were treated with STST from January 2010 through August 2015. Patients with mucosal prolapse were not considered eligible for STST. After a period of 24 months from surgery, all the patients were clinically evaluated with the intent to investigate the risk of recurrence of the preoperative symptoms.
RESULTS: All the patients were women (median age=54.7 years; ranges=37-75). Median discharge time was 1.5 days. One-month severe complications were: hemorrhoid thrombosis (6.0%), self-solved bleeding (6.0%), urinary retention (4.0%), anal secretion (4.0%) and urinary incontinence (1.0%). No post-operative cases of fecal incontinence were observed. Two years after surgery, 76.0% of patients reported a global improvement of the preoperative symptoms, with 73 and 35% of cases showing a reduced difficulty in the evacuation and need for digitation. Only 8.0% of patients showed a recurrence of the initial symptoms.
CONCLUSIONS: The STST is a feasible, safe, and cost-effective technique for the treatment of the rectocele without rectal mucosal prolapse. The method does not increase the risk of postoperative anal incontinence and presents a short hospital stay. STST presents long-term results in line with other transvaginal and transanal approaches.

KEY WORDS: Rectocele; Defecation; Therapeutics