Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial.
OBJECTIVE
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.
Ospedale Maggiore di Milano I.R.C.C.S., University of Milan, Milan, Italy. pboccasanta@tiscali.it
Paolo
P
Boccasanta
Marco
M
Venturi
Angelo
A
Stuto
Corrado
C
Bottini
Angelo
A
Caviglia
Alfonso
A
Carriero
Domenico
D
Mascagni
Roberto
R
Mauri
Luigi
L
Sofo
Vincenzo
V
Landolfi
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D003248:Constipation / Q000209:etiology / Q000628:therapy; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D007443:Intussusception / Q000150:complications* / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D020047:Rectocele / Q000150:complications* / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012720:Severity of Illness Index; D013537:Sutures; D016896:Treatment Outcome