title: Combined perineal and endorectal repair of rectocele by circular stapler: a novel surgical technique.
abstract: OBJECTIVE
  The aim of this study was to present a new technique for treatment of disabling rectocele when associated with internal mucosal prolapse or hemorrhoids using a 33-mm circular stapler.
  
  
  METHODS
  Eight female patients complaining of obstructed defecation because of distention rectocele associated with internal mucosal prolapse or hemorrhoids and perineal descent entered the study. The rectovaginal septum was opened by diathermy up to the end of the rectal wall weakness. The perineal wound and the anus were held open by a self-retractor. Using a transparent anoscope (PPH 01 system), 2 mucosal pursestrings were prepared 5 and 8 to 9 cm distant from the dentate line. Posteriorly, only the submucosa was included in the pursestring; anteriorly, it included the rectal wall, which was kept separate from the vaginal wall. A transanal 33-mm circular stapler was then used to close the rectocele and treat the mucosal prolapse. Before closing the perineum a levatorplasty was fashioned.
  
  
  RESULTS
  One patient had a vaginal tear during dissection of the septum, which healed spontaneously in one month. No other complications were recorded. Postoperative defecography showed correction of the rectocele and the posterior rectal prolapse in all patients. In two of them, a small lateral diverticulum could be seen, although this was asymptomatic. After a median follow-up of 12 months, all had significantly improved defecation (chronic constipation score dropped from 14.3 to 5, P < 0.04).
  
  
  CONCLUSIONS
  Combined perineal and endorectal stapler repair of rectocele may be a useful new surgical tool for correcting distention rectocele associated with mucosal prolapse or hemorrhoids and perineal descent in selected patients. A longer follow-up on a larger number of patients is needed to confirm these preliminary results.
authors.affiliation: Department of Emergency and Organ Transplantation, General Surgery and Liver Transplantation Units, University of Bari, Policlinico, piazza G. Cesare 11, 70124 Bari, Italy.
authors.forename: Donato F
authors.initials: DF
authors.lastname: Altomare
authors.forename: Marcella
authors.initials: M
authors.lastname: Rinaldi
authors.forename: Antonella
authors.initials: A
authors.lastname: Veglia
authors.forename: Maria
authors.initials: M
authors.lastname: Petrolino
authors.forename: Michele
authors.initials: M
authors.lastname: De Fazio
authors.forename: Pierluca
authors.initials: P
authors.lastname: Sallustio
mesh_terms: D000328:Adult; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006484:Hemorrhoids / Q000150:complications / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D010502:Perineum / Q000601:surgery; D012005:Rectal Prolapse / Q000150:complications / Q000601:surgery; D020047:Rectocele / Q000150:complications / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D013528:Surgical Staplers; D016896:Treatment Outcome