title: Laparoscopic correction of enterocele associated to stapled transanal rectal resection for obstructed defecation syndrome.
abstract: OBJECTIVE
  We report our experience of concomitant laparoscopic treatment for enterocele and stapled transanal rectal resection (STARR) for rectocele and/or rectal prolapse in patients with complex obstructed defecation syndrome (ODS).
  
  
  METHODS
  From June 2005 to June 2007, we submitted 20 patients with ODS due to rectal prolapse and/or rectocele, combined with stable enterocele, to STARR and laparoscopic correction of the enterocele. Preoperative assessment included symptom evaluation with standardized questionnaires, clinical examination, colonoscopy, proctoscopy, anal sphincter ultrasonography, video-defecography with synchronous opacification of the ileal loops in all patients and colpography in female patients, and anorectal manometry. Follow-up was performed in the first, third, sixth, 12th, and 24th month after surgery.
  
  
  RESULTS
  Eighteen (90%) patients were submitted to both procedures, simultaneously. One patient, previously submitted to STARR, underwent laparoscopic treatment of the enterocele. Postoperative complications occurred in two (10%) patients: one case of postoperative rectal bleeding and one case of retropneumoperitoneum. Median (range) preoperative and postoperative Altomare's obstructed defecation score was ten (6-14) and two (0-14), respectively (p<0.001). Median (range) preoperative and postoperative quality of life score was 79 (39-109) and 109 (50-126), respectively (p<0.001). No symptom related to ODS was detected at 6-month follow-up (19 patients) and at 24-month follow-up (19 patients).
  
  
  CONCLUSIONS
  The combination of STARR and laparoscopy provides a safe and effective method to treat ODS caused by rectal internal prolapse and/or rectocele combined with enterocele.
authors.affiliation: Pelvic Floor Center, Montecchio Emilia, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Carriero
authors.forename: Marcello
authors.initials: M
authors.lastname: Picchio
authors.forename: Jacopo
authors.initials: J
authors.lastname: Martellucci
authors.forename: Pasquale
authors.initials: P
authors.lastname: Talento
authors.forename: Domenico
authors.initials: D
authors.lastname: Palimento
authors.forename: Erasmo
authors.initials: E
authors.lastname: Spaziani
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D003672:Defecation / Q000502:physiology*; D019841:Defecography; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011182:Postoperative Care; D011300:Preoperative Care; D011788:Quality of Life; D020047:Rectocele / Q000503:physiopathology* / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D017792:Surgical Stapling