Avaliação clínica e anátomo-funcional dos pacientes com síndrome da defecação obstruída associada a retocele submetidos ao procedimento trrems - transanal repair of rectocele and rectal mucosectomy with a single circularstapler. fatores preditivos e resultados

Abstract

Clinical and anatomical-functional evaluation of patients with obstructed defecation syndrome associated with rectocele submitted to TRREMS procedure - Transanal Repair of rectocele and rectal mucosectomy with a single Circular stapler. Predictive factors and outcomes. Adjra da Silva Vilarinho, A Stricto Sensu Master of Medical-Surgical Sciences, Faculty of Medicine of the Federal University of Ceará (Master's thesis). September, 2018. Advisor: Francisco Sergio Pinheiro Regadas MD; PhD. Rectocele is an anatomical defect characterized as an herniation of the anterior wall of the upper anal canal and lower rectum, compressing the posterior wall of the vagina during evacuation, which is present in 97% of the patients with obstructed defecation. The aim of this study was to evaluate the impact of TRREMS (transanal repair of rectocele and rectal mucosectomy with a single circular stapler) procedure on treatment of obstructed defecation due to rectocele and identify the predictive factors for unsuccessful results. Methods: It was included patients with symptoms of obstructed defecation due to rectocele grade II/III who underwent to TRREMS procedure. Each patient was assessed with Cleveland Clinic Florida (CCF) constipation score before surgery and after 6 months of follow-up, calculating the rate of reduction of constipation score. They were also submitted to echodefecography, anorectal manometry and colonic transit time. Associated anatomical and functional factors such as menopause, anismus treated by biofeedback, intussusception and / or rectal mucosal prolapse, and postoperative complications were analyzed and compared with the rate of reduction of the CCF constipation score. Results: Eighty one patients were included. Nineteen (23.4%) presented grade II and 62 (76.5%) grade III rectocele, associated with intussusception and / or rectal mucosal prolapse in 51 (62.9%) and anismus in 25 (30.8%) patients. Sixty patients (74%) were postmenopausal. It was reported postoperative complications in 19 (23,4%) patients. One (1,2%) early bleeding, 1(1,2%) thrombosis, 7 (8,6%) with tenesmus symptoms (treated with analgesia and anti-inflammatory), 6 (7,4%) stenosis (4 treated with digital dilatation and 2 with endoscopic stricturectomy) and 4 (4,9%) residual rectal mucosa prolapses treated with rubber band ligation. The median postoperative score decreased significantly from 13 to 4. Fifty five (67.9%) and 24 (29.6%) presented an optimal and satisfactory response, with a constipation score reduction ≥ 70% and ≥50%, respectively. Patients with anismus, even previously treated with BIO, had a lower reduction in the CCF constipation score compared with patients without anismus. Conclusion: TRREMS procedure demonstrated a significant improvement of obstructed defecation symptoms and the factor associated with a higher risk of failure includes anismus even previously treated by biofeedback. Keywords: Obstructed defecation; Rectocele; Stapler.