title: The evolution of transfixed sequential suturing technique (TSST) in the treatment of rectocele: advantages and efficacy in 10 cases.
abstract: OBJECTIVE
  Rectocele, or posterior vaginal prolapse, is considered a herniation of the anterior rectal and posterior vaginal wall into the lumen of the vagina, which arises from either a tear or an attenuation of the rectovaginal (Denonvilliers') fascia. To date, all the surgical techniques proposed both through the anus and through the vagina have not demonstrated a real clinical efficacy in terms of a complete solution of this anatomic disorder. The authors of the present study have improved the surgical treatment outcome of rectocele introducing a new technique called transfix sequential suturing technique (TSST). Hereby its evolution is described, using a new suture called Monofil (Assut Europe s.p.a., Magliano dei Marsi, L'Aquila, Italy) and a new single-use operating kit.
  
  
  METHODS
  Ten consecutive female outpatients were treated surgically, after diagnosis of rectocele has been made both clinically and by imaging. Seven patients were found at stage 2 and three at stage 3 rectocele. The surgical technique performed was the same in all patients, and consisted in fixing sutures sequentially into the rectum until a complete closure of the rectocele pouch was obtained. All patients underwent a gloved finger examination of the rectum, anoscopy with the sphere-test, a defecagram and a total colonoscopy. Each patient was asked to fill a Quality of Life questionnaire (Agachan-Wexner Score) before surgery, and after three and six months of follow-up.
  
  
  RESULTS
  In our series, no serious postoperative complication was registered. The Quality of Life average score before treatment was 25, after three months of follow-up it decreased to 14, and to 12 after six months. The difference was found statistically significant (P<0.05).
  
  
  CONCLUSIONS
  The introduction of Monofil and that of a single-use operating kit demonstrated to be more efficacious in treating rectocele compared to TSST performed with an interrupted running suture and compared to other surgical techniques. Patients' quality of life improved significantly and a lower incidence of postoperative discomfort was found.
authors.affiliation: Department of General Surgery and Organ Transplantation, Paride Stefanini Institute, University of Rome, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Gaj
authors.forename: A
authors.initials: A
authors.lastname: Trecca
authors.forename: P
authors.initials: P
authors.lastname: Crispino
mesh_terms: D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D020047:Rectocele / Q000601:surgery*; D013536:Suture Techniques / Q000639:trends