title: TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler): a prospective multicenter trial.
abstract: BACKGROUND
  Since anorectocele is usually associated with mucosa prolapse and/or rectal intussusceptions, it was developed a stapled surgical technique using one circular stapler.
  
  
  OBJECTIVE
  To report the results of Transanal Repair of Rectocele and Rectal Mucosectomy with one Circular Stapler (TRREMS procedure) in the treatment of anorectocele with mucosa prolapse in a prospective multicenter trial.
  
  
  METHODS
  It was conducted by 14 surgeons and included 75 female patients, mean aged 49.6 years, with symptoms of obstructed defecation due to grade 2 (26.7%) and grade 3 (73.3%) anorectocele associated with mucosa prolapse and/or rectal intussusception (52.0%) and an average validated Wexner constipation score of 16. All patients were evaluated by a proctological examination, cinedefecography, anal manometry and colonic transit time. The TRREMS procedure consists of the manual removal of the rectocele wall with circumferential rectal mucosectomy performed with a circular stapler. The mean follow-up time was 21 months.
  
  
  RESULTS
  All patients presented obstructed defecation and they persisted with symptoms despite conservative treatment. The mean operative time was 42 minutes. In 13 (17.3%) patients, bleeding from the stapled line required hemostatic suture. Stapling was incomplete in 2 (2.6%). Forty-nine patients (65.3%) required 1 hospitalization day, the remainder (34.7%) 2 days. Postoperatively, 3 (4.0%) patients complained of persistent rectal pain and 7 (9.3%) developed stricture on the stapled suture subsequently treated by stricturectomy under anesthesia (n = 1), endoscopic stricturectomy with hot biopsy forceps (n = 3) and digital dilatation (n = 3). Postoperative cinedefecography showed residual grade I anorectoceles in 8 (10.6%). The mean Wexner constipation score decreased significantly from 16 to 4 (0-4: n = 68) (6: n = 6) (7: n = 1) (P<0.0001).
  
  
  CONCLUSIONS
  Current trial results suggest that TRREMS procedure is a safe and effective technique for the treatment of anorectocele associated with mucosa prolapse. The stapling technique is low-cost as requires the use of a single circular stapler.
authors.affiliation: School of Medicine, Federal University of Porto Alegre, RS, Brasil. jvcruz@terra.com.br
authors.forename: José Vinicius
authors.initials: JV
authors.lastname: Cruz
authors.forename: Francisco Sergio P
authors.initials: FS
authors.lastname: Regadas
authors.forename: Sthela Maria
authors.initials: SM
authors.lastname: Murad-Regadas
authors.forename: Lusmar Veras
authors.initials: LV
authors.lastname: Rodrigues
authors.forename: Fernando
authors.initials: F
authors.lastname: Benicio
authors.forename: Rogério
authors.initials: R
authors.lastname: Leal
authors.forename: César G
authors.initials: CG
authors.lastname: Carvalho
authors.forename: Margarete
authors.initials: M
authors.lastname: Fernandes
authors.forename: Lucimar M C
authors.initials: LM
authors.lastname: Roche
authors.forename: Antônio Carlos
authors.initials: AC
authors.lastname: Miranda
authors.forename: Lucia
authors.initials: L
authors.lastname: Câmara
authors.forename: Joaquim Costa
authors.initials: JC
authors.lastname: Pereira
authors.forename: Antonio Mallén
authors.initials: AM
authors.lastname: Parra
authors.forename: Vilmar Moura
authors.initials: VM
authors.lastname: Leal
mesh_terms: D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D007443:Intussusception / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012005:Rectal Prolapse / Q000601:surgery*; D020047:Rectocele / Q000150:complications / Q000601:surgery*; D012720:Severity of Illness Index; D017792:Surgical Stapling / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome