TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler): a prospective multicenter trial

Cruz, Jose Vinicius; Regadas, Francisco Sérgio Pinheiro; Murad-Regadas, Sthela M.; Rodrigues, Lusmar Veras; Benicio, Fernando; Leal, Rogério; Carvalho, Caetana M.; Fernandes, Margarete; Roche, Lucimar M. C.; Miranda, Antônio Carlos de; Câmara, Lucia; Pereira, Joaquim Costa; Parra, Antonio Mallén; Leal, Vilmar Moura

doi:10.1590/s0004-28032011000100002

Cited by 16 publications

(10 citation statements)

References 27 publications

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“…Many forms of treatment have been proposed with varying results, including fiber ingestion, laxatives, biofeedback therapy, electrostimulation, sacral nerve stimulation and surgical repair (8,9,12,13,21,23,27) . A total of 175 patients with obstructed defecation syndrome and a Wexner's constipation score ≥6.0 were assessed with 3-D dynamic anorectal ultrasonography (echodefecography) to identify pelvic floor dysfunctions in the posterior compartment (rectocele, intussusception, mucosal prolapse and anismus) and the middle compartment (Grade-III enterocele/sigmoidocele).…”

Section: Discussionmentioning

confidence: 99%

“…After excluding patients with slow transit and reduced anal pressure, 23 subjects were submitted to rectocele repair with the TR-REMS procedure (transanal repair of rectocele and rectal mucosectomy with a single circular stapler) which makes it possible to remove the anorectal mucosa circumferentially and reinforce the anterior anorectal junction wall with the use of a single circular stapler and a novel surgical device kit (9) . The few observed complications (2/23; 8.7%) were easily treated during hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…The TRREMS procedure (transanal repair of rectocele and rectal mucosectomy using a single circular stapler) was used, as previously described by Cruz et al (9) . After a full mechanical bowel preparation, patients were placed in the Lloyd-Davis position under spinal anesthesia.…”

Section: Surgical Techniquementioning

confidence: 99%

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Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome

Murad-Regadas

Regadas

Rodrigues

et al. 2012

Arq. Gastroenterol.

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-Context -Management of patients with obstructed defecation syndrome is still controversial. Objective -To analyze the efficacy of clinical, clinical treatment followed by biofeedback, and surgical treatment in patients with obstructed defecation, rectocele and multiple dysfunctions evaluated with echodefecography. Methods -The study included 103 females aged 26-84 years with obstructed defecation, grade-II/III rectocele and multiple dysfunctions on echodefecography. Patients were distributed into three treatment groups and constipation scores were assigned. Group I: 34 (33%) patients with significant improvement of symptoms through clinical management only. Group II: 14 (14%) with improvement through clinical treatment plus biofeedback. Group III: 55 (53%) referred to surgery due to treatment failure. Results -Group I: 20 (59%) patients had grade-II rectocele, 14 (41%) grade-III. Obstructed defecation syndrome was associated with intussusception (41%), mucosal prolapse (41%), anismus (29%), enterocele (9%) or 2 dysfunctions (23%). The average constipation score decreased significantly from 11 to 5. Group II: 11 (79%) grade-II rectocele, 3 (21%) grade-III, associa ted with intussusception (7%), mucosal prolapse (43%), anismus (71%) or 2 dysfunctions (29%). There was significant decrease in constipation score from 13 to 6. Group III: 8 (15%) grade-II rectocele, 47 (85%) grade-III, associated with intussusception (42%), mucosal prolapse (40%) or 2 dysfunctions (32%). The constipation score remained unchanged despite clinical treatment and biofeedback. Twenty-three underwent surgery had a significantly decrease in constipation score from 12 to 4. The remaining 32 (31%) patients which 22 refused surgery, 6 had low anal pressure and 4 had slow transit. Conclusions -Approximately 50% of patients with obstructed defecation, rectocele and multiple dysfunctions presented a satisfactory response to clinical treatment and/or biofeedback. Surgical repair was mainly required in patients with grade-III rectocele whose constipation scores remained high despite all efforts. HEADINGS -Rectocele. Constipation. Pelvic floor. Imaging, three-dimensional.None disclosure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome

Murad-Regadas

Regadas

Rodrigues

et al. 2012

Arq. Gastroenterol.

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“…In this current issue of ARQUIVOS de GASTROENTEROLOGIA a multicentric study with the use of mechanical suture in rectocele surgical correction is published (2) . The evolution of mechanical sutures by means of stapler use has become a real technological advancement process, as it has represented the concept of a new product with the combination of new functions that have resulted in improvements and effective gains of quality or productivity in the handicraft suture process that has been done by surgeons for centuries, particularly in visceral anastomoses.…”

mentioning

confidence: 99%

“…In colon's resection, staplers had long increased as well as laparoscopic approach, allowing its use in a large number of segments of the anastomoses with linear or circular staplers. Several randomized trials have demonstrated the effectiveness of the PPH (procedure for prolapsed and hemorroidopexy) (9) in the treatment of hemorrhoids (3,7) , and rectal prolapsed, with special attention to the selection of indications (2) .…”

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confidence: 99%