Skip to main content
SpringerLink
Log in

Stapled Transanal Rectal Resection for Outlet Obstruction: A Prospective, Multicenter Trial

  • Technical Notes
  • Published:
Diseases of the Colon & Rectum

PURPOSE:

This prospective, multicenter trial was designed to assess the safety and effectiveness of a novel technique in the treatment of outlet obstruction caused by the combination of intussusception and rectocele by using a double-transanal, 33-mm circular stapler.

METHODS:

From January to October 2001, 90 patients with outlet obstruction were operated on and followed (mean, 16.3 ± 2.9 months) by the validated Constipation Scoring and Continence Grading Systems, clinical examination, defecography, and anorectal manometry. Anal ultrasound also was performed in 58 multiparous patients.

RESULTS:

Operative time and hospital stay were short (mean, 43.3 ± 8.7 minutes and 2.1 ± 0.8 days, respectively), and postoperative pain was minimal. The mean time to resume normal activity was 10.2 ± 4.5 days. Complications were 17.8 percent fecal urgency, 8.9 percent incontinence to flatus, 5.5 percent urinary retention, 4.4 percent bleeding, 3.3 percent anastomotic stenosis, and 1.1 percent pneumonia. All constipation symptoms significantly improved (P < 0.001) without worsening of anal continence. No patient complained of dyspareunia. At postoperative defecography, all patients had a double incisure of the lower rectal outline in the site of anastomosis, with the disappearance of both intussusception and rectocele. Anal pressure was not significantly modified, whereas rectal compliance was restored (P < 0.05). No lesions of anal sphincters caused by the operation were found in multiparous patients. The outcome at one year was excellent in 48 of 90 patients, good in 33, fairly good in 5, and poor in 4.

CONCLUSIONS:

This novel technique seems to be safe and effective in the treatment of outlet obstruction caused by the combination of intussusception and rectocele. Randomized trials are required to confirm these findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.
Fig. 3.
Fig. 4.
Fig. 5.
Fig. 6.
Fig. 7.
Fig. 8.

Similar content being viewed by others

REFERENCES

To the article

  1. C Fucini O Ronchi C Elbetti (2001) ArticleTitleElectromyography of the pelvic floor musculature in the assessment of obstructed defecation symptoms Dis Colon Rectum 44 1168–75 Occurrence Handle1:STN:280:DC%2BD3MvptFOitw%3D%3D Occurrence Handle11535858

    CAS  PubMed  Google Scholar 

  2. AC Lowry CL Simmang P Boulos et al. (2001) ArticleTitleConsensus statement of definitions for anorectal physiology and rectal cancer Dis Colon Rectum 44 915–9 Occurrence Handle1:STN:280:DC%2BD3MvkvFSisg%3D%3D Occurrence Handle11496067

    CAS  PubMed  Google Scholar 

  3. A Mellgren S Bremmer (1994) ArticleTitleDefecography, results of investigation in 2816 patients Dis Colon Rectum 37 1133–41 Occurrence Handle1:STN:280:ByqD2cvms1E%3D Occurrence Handle7956583

    CAS  PubMed  Google Scholar 

  4. I Schultz A Mellgren A Dolk C Johansson B Holstrom (1996) ArticleTitleContinence is improved after Ripstein’s rectopexy: different mechanisms in rectal prolapse and rectal intussusception? Dis Colon Rectum 39 300–6 Occurrence Handle1:STN:280:BymC1cvkvVY%3D Occurrence Handle8603552

    CAS  PubMed  Google Scholar 

  5. AJ Senagore MA Luchtefeld JM Keigan ParticleMac (1993) ArticleTitleRectopexy J Laparoendosc Surg 3 339–43 Occurrence Handle1:STN:280:ByuD1MzgsVw%3D Occurrence Handle8268503

    CAS  PubMed  Google Scholar 

  6. HP Bruch A Herold T Schiedeck O Schwandner (1999) ArticleTitleLaparoscopic surgery for rectal prolapse and outlet obstruction Dis Colon Rectum 42 1189–95 Occurrence Handle1:STN:280:DyaK1MvisVykuw%3D%3D Occurrence Handle10496560

    CAS  PubMed  Google Scholar 

  7. IR Berman MS Harris MB Rabeler (1990) ArticleTitleDelorme’s transrectal excision for internal rectal prolapse: patient selection, technique, and three-year follow-up Dis Colon Rectum 33 573–80 Occurrence Handle1:STN:280:By%2BB1MfntlY%3D Occurrence Handle2193784

    CAS  PubMed  Google Scholar 

  8. JR Block (1986) ArticleTitleTransrectal repair of rectocele using obliterative suture Dis Colon Rectum 29 707–11 Occurrence Handle1:STN:280:BiiD38bntlQ%3D Occurrence Handle3533470

    CAS  PubMed  Google Scholar 

  9. IT Khubchandani JA Sheets JJ Stasik AR Hakki (1983) ArticleTitleEndorectal repair of rectocele Dis Colon Rectum 26 792–6 Occurrence Handle1:STN:280:BiuD2MjhtV0%3D Occurrence Handle6641461

    CAS  PubMed  Google Scholar 

  10. S Sehapayak (1985) ArticleTitleTransrectal repair of rectocele: an extended armamentarium of colorectal surgeons. A report of 335 cases Dis Colon Rectum 28 422–33 Occurrence Handle1:STN:280:BiqB38bovVE%3D Occurrence Handle3891260

    CAS  PubMed  Google Scholar 

  11. CJ Laarhoven Particlevan MA Kamm CI Bartram S Halligan PR Hawley RK Phillips (1999) ArticleTitleRelationship between anatomic and symptomatic long-term results after rectocele repair for impaired defecation Dis Colon Rectum 42 204–11 Occurrence Handle10211497

    PubMed  Google Scholar 

  12. WE Porter A Steele P Walsh N Kohli MM Karram (1999) ArticleTitleThe anatomic and functional outcomes of defect-specific rectocele repairs Am J Obstet Gynecol 181 1353–8 Occurrence Handle1:STN:280:DC%2BD3c%2FmvVCitA%3D%3D Occurrence Handle10601912

    CAS  PubMed  Google Scholar 

  13. FR Zacharin NT Hamilton (1980) ArticleTitlePulsion enterocele: long-term results of an abdominoperineal technique Obstet Gynecol 2 141–8

    Google Scholar 

  14. M Pescatori U Favetta S Dedola S Orsini (1997) ArticleTitleTransanal stapled excision of rectal mucosal prolapse Tech Coloproctol 1 96–8

    Google Scholar 

  15. DF Altomare M Rinaldi A Veglia M Petrolino M Fazio ParticleDe PL Sallustio (2002) ArticleTitleCombined perineal and endorectal repair of rectocele by circular stapler: a novel surgical technique Dis Colon Rectum 45 1549–52 Occurrence Handle12432306

    PubMed  Google Scholar 

  16. P Boccasanta M Venturi G Calabrò et al. (2001) ArticleTitleWhich surgical approach for rectocele? A multicentric report from Italian coloproctologists Tech Coloproctol 5 147–54

    Google Scholar 

  17. F Agachan T Chen J Pfeifer P Reisman SD Wexner (1996) ArticleTitleA constipation scoring system to simplify evaluation and management of constipated patients Dis Colon Rectum 39 681–5 Occurrence Handle8646957

    PubMed  Google Scholar 

  18. J Oliveira J Pfeiffer SD Wexner (1996) ArticleTitlePhysiological and clinical outcome of anterior sphincteroplasty Br J Surg 83 502–5 Occurrence Handle1:STN:280:BymB28zhsVQ%3D Occurrence Handle8665241

    CAS  PubMed  Google Scholar 

  19. P Mahieu J Pringot P Bodart (1984) ArticleTitleDefecography: II. Contribution to the diagnosis of defecation disorders Gastrointest Radiol 9 253–61 Occurrence Handle1:STN:280:BiuB1cnlvFA%3D Occurrence Handle6468863

    CAS  PubMed  Google Scholar 

  20. G Costalat JM Garrigues F Drawed P Noel M Veyrac J Vernhet (1989) ArticleTitleRectopexie antero-posterieure pour troubles de la statique rectale: resultats cliniques et radiologiques. Interet de la rectographie dinamique numerisée. A propos de trente cas Ann Chir 43 733–43 Occurrence Handle1:STN:280:By%2BC3czktVw%3D Occurrence Handle2604361

    CAS  PubMed  Google Scholar 

  21. CW Lau S Heymen O Alabaz AJ Iroatulam SD Wexner (2000) ArticleTitlePrognostic significance of rectocele, intussusception, and abnormal perineal descent in biofeedback treatment for constipated patients with paradoxical puborectalis contraction Dis Colon Rectum 43 478–82 Occurrence Handle1:STN:280:DC%2BD3c3kvVKjtg%3D%3D Occurrence Handle10789742

    CAS  PubMed  Google Scholar 

  22. MC Marti J Deleaval B Roche (1999) ArticleTitleRectoceles: value of videodefecography in selection of treatment policy Colorect Dis 1 324–9

    Google Scholar 

  23. G Basilisco P Velio PA Bianchi (1997) ArticleTitleOesophageal manometry in the evaluation of megacolon with onset in adult life Gut 40 188–91 Occurrence Handle1:STN:280:ByiB38rlvVM%3D Occurrence Handle9071929

    CAS  PubMed  Google Scholar 

  24. M Sorensen OO Rasmussen T Tetzschner J Christiansen (1992) ArticleTitlePhysiological variation in rectal compliance Br J Surg 79 1106–8 Occurrence Handle1:STN:280:ByyD2crjslA%3D Occurrence Handle1422734

    CAS  PubMed  Google Scholar 

  25. A Frudinger CI Bartram S Halligan M Kamm (1998) ArticleTitleExamination techniques for endosonography of the anal canal Abdom Imaging 23 301–3 Occurrence Handle1:STN:280:DyaK1c3jslKrtw%3D%3D Occurrence Handle9569302

    CAS  PubMed  Google Scholar 

  26. NA Rotholtz JE Efron EG Weiss JJ Nogueras SD Wexner (2002) ArticleTitleAnal manometric predictors of significant rectocele in constipated patients Tech Coloproctol 6 73–7 Occurrence Handle1:STN:280:DC%2BD38nktlWrtw%3D%3D Occurrence Handle12402049

    CAS  PubMed  Google Scholar 

  27. JS Choi YH Hwang MR Salum et al. (2001) ArticleTitleOutcome and management of patients with large rectoanal intussusception Am J Gastroenterol 96 740–4 Occurrence Handle1:STN:280:DC%2BD3M7ovFOktA%3D%3D Occurrence Handle11280544

    CAS  PubMed  Google Scholar 

  28. T Mimura AJ Roy JB Storrie MA Kamm (2000) ArticleTitleTreatment of impaired defecation associated with rectocele by behavioral retraining (biofeedback) Dis Colon Rectum 43 1267–72 Occurrence Handle1:STN:280:DC%2BD3cvltVGisw%3D%3D Occurrence Handle11005495

    CAS  PubMed  Google Scholar 

  29. B Holmstrom G Broden A Dolk (1986) ArticleTitleResults of the Ripstein operation in the treatment of rectal prolapse and internal rectal procidentia Dis Colon Rectum 29 845–8 Occurrence Handle1:STN:280:BiiD2sbpt10%3D Occurrence Handle3792166

    CAS  PubMed  Google Scholar 

  30. MR Keighley JW Fielding J Alexander-Williams (1983) ArticleTitleResults of Marlex mesh abdominal rectopexy for rectal prolapse in 100 consecutive patients Br J Surg 70 229–32 Occurrence Handle1:STN:280:BiyC2Mvlt1c%3D Occurrence Handle6831177

    CAS  PubMed  Google Scholar 

  31. WJ Orrom DC Bartolo R Miller NJ Mortensen AM Roe (1991) ArticleTitleRectopexy is ineffective treatment of obstructed defecation Dis Colon Rectum 34 41–6 Occurrence Handle1:STN:280:By6C387ptl0%3D Occurrence Handle1991419

    CAS  PubMed  Google Scholar 

  32. GS Duthie DC Bartolo (1992) ArticleTitleAbdominal rectopexy for rectal prolapse: a comparison of technique Br J Surg 79 107–13 Occurrence Handle1:STN:280:By2B3cfmslQ%3D Occurrence Handle1555053

    CAS  PubMed  Google Scholar 

  33. P Boccasanta R Rosati M Venturi et al. (1999) ArticleTitleSurgical treatment of complete rectal prolapse: results of abdominal and perineal procedures J Laparoendosc Adv Surg Tech 9 235–8 Occurrence Handle1:STN:280:DyaK1MzktFCrug%3D%3D

    CAS  Google Scholar 

  34. H Lieberman C Hughes A Dippolito (2000) ArticleTitleEvaluation and outcome of the Delorme procedure in the treatment of rectal outlet obstruction Dis Colon Rectum 43 188–92 Occurrence Handle1:STN:280:DC%2BD3c7lvF2ltw%3D%3D Occurrence Handle10696892

    CAS  PubMed  Google Scholar 

  35. I Sielezneff A Malouf J Cesari C Brunet JC Sarles B Sastre (1999) ArticleTitleSelection criteria for internal rectal prolapse repair by Delorme’s transrectal excision Dis Colon Rectum 42 367–73 Occurrence Handle1:STN:280:DyaK1M3jvVaktg%3D%3D Occurrence Handle10223758

    CAS  PubMed  Google Scholar 

  36. SE Kuah KW Lee CR Houghton AR Korda (2000) ArticleTitleThe management of pulsion rectocele with the Zacharin abdominoperineal technique (and mesh sacrocolpopexy) ANZ J Obstet Gynaecol 40 303–7 Occurrence Handle1:STN:280:DC%2BD3crhtVGqsQ%3D%3D

    CAS  Google Scholar 

  37. GM Brieger AR Kordan CR Houghton (1996) ArticleTitleAbdominoperineal repair of pulsion rectocele J Obstet Gynaecol Res 22 151–6 Occurrence Handle1:STN:280:BymB1c%2FivFU%3D Occurrence Handle8697345

    CAS  PubMed  Google Scholar 

  38. P Roos (2000) ArticleTitleHaemorrhoid surgery revised Lancet 355 1648 Occurrence Handle1:STN:280:DC%2BD3c3nvFCisQ%3D%3D

    CAS  Google Scholar 

  39. RG Molloy D Kingsmore (2000) ArticleTitleLife-threatening pelvic sepsis after stapled haemorrhoidectomy Lancet 355 810 Occurrence Handle10.1016/S0140-6736(00)02208-X Occurrence Handle1:STN:280:DC%2BD3c7nsFSqug%3D%3D Occurrence Handle10711934

    Article  CAS  PubMed  Google Scholar 

  40. A Herold JJ Kirsh (2000) ArticleTitlePain after stapled haemorrhoidectomy Lancet 356 2187 Occurrence Handle10.1016/S0140-6736(00)03510-8 Occurrence Handle1:STN:280:DC%2BD3M%2FpsVCrug%3D%3D

    Article  CAS  Google Scholar 

  41. BD Kriss JA Porter AF Slezak (1990) ArticleTitleRetroperitoneal air after hemorrhoidectomy: report of a case Dis Colon Rectum 33 971–3 Occurrence Handle1:STN:280:By6D3s%2FoslM%3D Occurrence Handle2226086

    CAS  PubMed  Google Scholar 

  42. KJ Murphy (1978) ArticleTitleTetanus after rubber-band ligation of haemorrhoids BMJ 1 1590–1 Occurrence Handle1:STN:280:CSeC1cfhsVM%3D

    CAS  Google Scholar 

  43. VS O’Hara (1980) ArticleTitleFatal clostridial infection following hemorrhoidal banding Dis Colon Rectum 23 570–1 Occurrence Handle1:STN:280:Bi6C3MzksF0%3D Occurrence Handle7460695

    CAS  PubMed  Google Scholar 

  44. FJ Scarpa W Hillis JR Sabetta (1988) ArticleTitlePelvis cellulitis: is a life-threatening complication of hemorrhoidal banding Surgery 103 383–5 Occurrence Handle1:STN:280:BieC2crpt10%3D Occurrence Handle3278407

    CAS  PubMed  Google Scholar 

  45. J Barwell RM Watkins E Lloyd-Davies DC Wilkins (1999) ArticleTitleLife-threatening retroperitoneal sepsis after hemorrhoid injection sclerotherapy Dis Colon Rectum 42 421–3 Occurrence Handle1:STN:280:DyaK1M3jvVarsQ%3D%3D Occurrence Handle10223767

    CAS  PubMed  Google Scholar 

  46. A Maw KW Eu F Seow-Chen (2002) ArticleTitleRetroperitoneal sepsis complicating stapled hemorrhoidectomy Dis Colon Rectum 45 826–8 Occurrence Handle10.1007/s10350-004-6304-z Occurrence Handle12072637

    Article  PubMed  Google Scholar 

  47. RJ Felt-Bersma MA Cuesta M Koorevaar et al. (1992) ArticleTitleAnal endosonography: relationship with anal manometry and neurophysiologic tests Dis Colon Rectum 35 944–9 Occurrence Handle1:STN:280:ByyD3M%2Fhs1w%3D Occurrence Handle1395981

    CAS  PubMed  Google Scholar 

  48. RJ Felt-Bersma AC Poen MA Cuesta SG Meuwissen (1997) ArticleTitleAnal sensitivity test: what does it measure and do we need it ? Cause or derivative of anorectal complaints Dis Colon Rectum 40 811–6 Occurrence Handle1:STN:280:ByiA28vptV0%3D Occurrence Handle9221858

    CAS  PubMed  Google Scholar 

  49. RJ Felt-Bersma R Baren Particlevan M Koorevaar RL Strijers MA Cuesta (1995) ArticleTitleUnsuspected sphincter defects shown by anal endosonography after anorectal surgery. A prospective study Dis Colon Rectum 38 249–53 Occurrence Handle1:STN:280:ByqC1cfmsFE%3D Occurrence Handle7882786

    CAS  PubMed  Google Scholar 

  50. YH Ho WK Cheong C Tsang et al. (2000) ArticleTitleStapled hemorrhoidectomy -cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry and endoanal ultrasound assessment at up to three months Dis Colon Rectum 43 1666–75 Occurrence Handle1:STN:280:DC%2BD3M%2FpvFGrtQ%3D%3D Occurrence Handle11156449

    CAS  PubMed  Google Scholar 

  51. MJ Gosselink WC Hop WR Schouten (2001) ArticleTitleRectal compliance in females with obstructed defecation Dis Colon Rectum 44 971–7 Occurrence Handle1:STN:280:DC%2BD3MvkvFSitA%3D%3D Occurrence Handle11496077

    CAS  PubMed  Google Scholar 

  52. V Piloni F Pomerri E Platania et al. (1994) ArticleTitleThe National Workshop on Defecography: anorectal deformities with a functional origin (prolapse, intussusception, rectocele) Radiol Med 87 789–95 Occurrence Handle1:STN:280:ByuA3MnosFI%3D

    CAS  Google Scholar 

To the Invited Commentary

  1. PJ Shorvon S McHugh NE Diamant S Somers GW Stevenson (1989) ArticleTitleDefaecography in normal volunteers: results and implications Gut 30 1737–49 Occurrence Handle1:STN:280:By%2BC38fktFU%3D Occurrence Handle2612988

    CAS  PubMed  Google Scholar 

  2. JL McCue JP Thomson (1990) ArticleTitleRectopexy for internal rectal intussusception Br J Surg 77 632–4 Occurrence Handle1:STN:280:By%2BA2crhtl0%3D Occurrence Handle2383728

    CAS  PubMed  Google Scholar 

Download references

ACKNOWLEDGMENTS

The authors thank Prof. P. Ronan O’Connell, M.D., F.R.C.S.I./F.R.C.S., Consultant General and Colorectal Surgeon, Mater Private Hospital (Dublin), and Prof. Filippo Pucciani, Department of General Surgery, University of Florence, whose substantial contribution to the study was greatly appreciated.

Author information

Authors and Affiliations

  1. Ospedale Maggiore di Milano I.R.C.C.S., University of Milan, Milan, Italy

    Paolo Boccasanta M.D., E.B.S.Q. & Marco Venturi M.D.

  2. Pordenone General Hospital, Pordenone, Italy

    Angelo Stuto M.D.

  3. Gallarate General Hospital, Varese, Italy

    Corrado Bottini M.D.

  4. C. Forlanini General Hospital, Rome, Italy

    Angelo Caviglia M.D.

  5. Pelvic Floor Center, Montecchio Emilia, Italy

    Alfonso Carriero M.D.

  6. La Sapienza University of Rome, Rome, Italy

    Domenico Mascagni M.D.

  7. Erba General Hospital, Como, Italy

    Roberto Mauri M.D.

  8. Catholic University of Rome, Rome, Italy

    Luigi Sofo M.D.

  9. Solofra General Hospital, Avellino, Italy

    Vincenzo Landolfi M.D.

Authors
  1. Paolo Boccasanta M.D., E.B.S.Q.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco Venturi M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Angelo Stuto M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Corrado Bottini M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Angelo Caviglia M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alfonso Carriero M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Domenico Mascagni M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Roberto Mauri M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Luigi Sofo M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Vincenzo Landolfi M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paolo Boccasanta M.D., E.B.S.Q..

Additional information

Supported by a grant from “Fondazione Camillo Corti per la ricerca sulle malattie del colon,” Piazza Martini 9, I - 20137 Milano.

The Governing Council of the Italian Association of Coloproctology Units approved the study protocol. No financial contribution has been received from any potentially concerned party during the preparation of the trial.

About this article

Cite this article

Boccasanta, P., Venturi, M., Stuto, A. et al. Stapled Transanal Rectal Resection for Outlet Obstruction: A Prospective, Multicenter Trial. Dis Colon Rectum 47, 1285–1297 (2004). https://doi.org/10.1007/s10350-004-0582-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-004-0582-3

Key words

Search

Navigation