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Abstract
Background
The treatment of obstructed defecation is one of the currently most debated topics
in the field of surgery of the pelvic floor. For elderly people conservative methods
are often suggested. The aim of this study is to report clinical results of three
different surgical approaches for the correction of rectocele and anorectal prolapse.
Materials and methods
32 over 65-years old patients underwent surgery for obstructed defecation syndrome
and then observed prospectively by the Coloproctological Unit of Surgical Clinic III,
S. Antonio Hospital, Padova, from 2001 to 2007. All patients were evaluated with a
dedicated questionnaire: Knowles-Eccerseley-Scott score (KESS) for all patients and
Obstructed Defecation score (ODS) for two groups, proctological and gynecological
examination, colpocystodefecography before surgery and 6 months afterwards.
The three surgical techniques adopted were: posterior colporrhaphy and rectal mucosectomy
with mechanical circular stapler PPH01® (Ethicon Endo Surgery, Cincinnati, OH, USA)
(CPR-PPH Group), stapled transanal rectal resection with two stapler PPH01® (STARR
Group) and stapler rectal resection with CCS30 Contour Transtar® (Transtar Group).
In two cases we associated laparoscopic assistance to transanal technique in general
anaesthesia for suspected enterocele not confirmed by peritoneal exploration. All
other operations were performed in spinal anaesthesia.
Results
There was an improvement of post-operative symptoms in all approaches without significant
differences between the techniques. There was one major complication (suspected microperforation
of the rectum resolved with conservative therapy) in the Transtar Group. Medium KESS
score significantly decreased in all groups (from 16.2 to 4.8 in the first group,
from 18.8 to 5.7 in the second group, from 21.8 to 5.8 in the third group, p < 0.0001
Wilcoxon's test). Also Medium ODS significantly decreased in the two groups analyzed
(from 17.7 to 3.3 in STARR Group, from 21.2 to 4 in Transtar Group, p < 0.0001 Wilcoxon's
test). The STARR technique showed a benefit in reducing the operating time, the maintenance
of urinary catheter and hospital stay.
Conclusion
The surgical approaches proposed showed effectiveness and safety in improving symptoms
of obstructed defecation. This surgery fits also elderly patients because of the lower
surgical risk and the decreased hospital stay than traditional abdominal approaches.
In particular STARR procedure offers advantage in elderly patients because of reduced
operative time and hospital stay and reduced maintenance of urinary catheter.
[1
]University of Padua, Department of Surgical and Gastroenterologic Sciences, 3th General
Surgery Clinic, Coloproctological Unit, S. Antonio Hospital, Italy