title: TST36 stapling for rectocele and hemorrhoidal prolapse - early results of the prospective German multicenter study.
abstract: Introduction:The aim of the study was to evaluate the safety and feasibility of stapled transanal procedures performed by a 36 mm stapling device, the so-called TST36 stapler.Methods:From September 2013 to June 2014 a prospective observational study was carried out by 8 proctology centers in Germany. The Cleveland Clinic Incontinence Score (CCIS) for incontinence and the Altomare ODS score were determined preoperatively. Follow-up examinations were performed after 14 days, one month and 6 months, at this time both scores were reevaluated.Results:110 consecutive patients (71 women, 39 men) with a mean age of 59.7 years (±13.8 years) were included in the study. The eight participating institutes entered 3 to 31 patients each into the study. The indication for surgery was an advanced hemorrhoidal disease in 55 patients and ODS with rectal intussusception or rectocele in 55 patients. Mechanical problems with stapler introduction occurred in 22 cases (20%) and a partial stapleline dehiscence in 4 cases (3.6%). Additional stitches for bleeding from stapleline were necessary in 86 patients (78.2%). Reintervention was necessary for bleeding 7 times (6.3%). Severe complications during follow-up were stapleline dehiscence in one case and recurrent hemorrhoidal prolapse in 5 cases (4.5%). Altomare ODS score and CCIS improved significantly after surgery.Conclusions:Despite a notable complication rate during surgery and the postoperative period, the TST36 can be considered as an effective tool for low rectal stapling for anorectal prolapse causing hemorrhoids or obstructed defecation.
authors.affiliation: Department of General, Visceral and Vascular Surgery, Hospital Asklepios Altona, Hamburg, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Petersen
authors.affiliation: Center of Colorectal and Pelvic Floor Surgery, Hospital Waldfriede, Berlin, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Sterzing
authors.affiliation: Center of Coloproctology Essen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Ommer
authors.affiliation: Center of Colorectal and Pelvic Floor Surgery, Hospital Waldfriede, Berlin, Germany.
authors.forename: Assen
authors.initials: A
authors.lastname: Mladenov
authors.affiliation: Center of Proctology Gendarmenmarkt, Berlin, Germany.
authors.forename: Zrino
authors.initials: Z
authors.lastname: Nakic
authors.affiliation: Center of Coloproctology, Duesseldorf, Germany.
authors.forename: Faramaz
authors.initials: F
authors.lastname: Pakravan
authors.affiliation: Center of Coloproctology, Duesseldorf, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Wolff
authors.affiliation: Department of Visceral and Vascular Surgery, St. Hedwig Hospital Berlin, Germany.
authors.forename: Eric P M
authors.initials: EP
authors.lastname: Lorenz
authors.affiliation: Proctological Institute Stuttgart, Germany.
authors.forename: Ruediger L
authors.initials: RL
authors.lastname: Prosst
authors.affiliation: Department of Surgery, Bethesda General Hospital Bergedorf, Hamburg, Germany.
authors.forename: Marco
authors.initials: M
authors.lastname: Sailer
authors.affiliation: Center of Colorectal and Pelvic Floor Surgery, Hospital Waldfriede, Berlin, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Scherer
mesh_terms: D000368:Aged; D003248:Constipation / Q000209:etiology; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000601:surgery; D005858:Germany; D006484:Hemorrhoids / Q000150:complications / Q000601:surgery*; D006801:Humans; D007443:Intussusception / Q000150:complications / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011391:Prolapse; D011446:Prospective Studies; D020047:Rectocele / Q000150:complications / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D013528:Surgical Staplers / Q000009:adverse effects*; D017792:Surgical Stapling / Q000009:adverse effects* / Q000295:instrumentation; D013529:Surgical Wound Dehiscence / Q000209:etiology
keywords: hemorrhoids; obstructed defecation; prolapse; rectocele; stapled hemorrhoidectomy; stapled surgery