Comparison of Procedure for Prolapse and Hemorrhoids and Block Repair Procedure in Treatment for Rectocele_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YUAN Lu ¹ , GUO Jianbo ² , LIN Shusen ¹ , LI Chunyu. ¹

1. Department of Anorectal Surgery， The Fourth Affiliated Hospital of China Medical University， Shenyang 110032， Liaoning Province， China;;
2. Department of Synthetic Surgery， The Fourth Affiliated Hospital of China Medical University， Shenyang 110005， Liaoning Province，China;

Corresponding author：

Keywords：

Procedure for prolapse and hemorrhoids; Block repair procedure; Rectocele; Therapeutic effect

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Objective 　To compare the therapeutic effect of procedure for prolapse and hemorrhoids （PPH） and Block repair procedure for rectocele．
Methods 　A retrospective study of 62 patients with surgical treatment for rectocele was analyzed．The patients were divided into PPH group （n=32） and Block group （n=30） according to the different operation procedure．The symptoms score of improvement of the patients after surgery was compared between the two groups， including operation time，intraoperative blood loss， postoperative pain score， required analgesic times， postoperative complications，hospitalization time，and hospitalization expenses．
Results 　The symptoms of constipation of patients in two groups was significantly improved afer operation．Comparing one month with three months of Longo’s obstructed defecation syndrome （ODS） score after the operation，there was no significant difference in the PPH group（P＞0.05）， but significant difference in the Block group（P＜0.01）．Although the expenses of the PPH group was much higher than that of the Block group （P＜0.01）， the outcomes of the PPH group were much better than those of the Block group （P＜0.01）， including the postoperative Longo’s ODS score of one month and three months，operation time，intraoperative blood loss， postoperative pain score，required analgesic times，and hospitalization time．Two cases of lightly postoperative incontinence occurred in the PPH group，but completely recovered after three months in the clinical follow-up．
Conclusions 　The PPH is as safe and effective as Block repair procedure for rectocele. The short time effect and lower recurrence rate of the PPH are better than those of the Block repair procedure．

Citation： YUAN Lu,GUO Jianbo,LIN Shusen,LI Chunyu.. Comparison of Procedure for Prolapse and Hemorrhoids and Block Repair Procedure in Treatment for Rectocele. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(2): 151-156. doi: Copy

1.	尹淑慧，赵克，侯庆香，等．吻合器经肛直肠切除术与经阴道手术治疗直肠前突的比较[ J]．中国普外基础与临床杂志， 2010，17(2)：129-132．.
2.	Dietz H．Rectocele or stool quality：what matters more for symptoms of obstructed defecation?[J]．Tech Coloproctol，2009， 13(4)：265-268．.
3.	Renzi A，Izzo D，Di Sarno G，et al．Stapled transanal rectal resection to treat obstructed defecation caused by rectal intussusception and rectocele[J]．Int J Colorectal Dis，2006，21(7)：661667．.
4.	Boccasanta P，Venturi M，Stuto A，et al．Stapled transanal rectal resection for outlet obstruction：a prospective，multicenter trial[J]．Dis Colon Rectum，2004，47(8)：1285-1297．.
5.	Chen HH，Iroatulam A，Alabaz O，et al．Associations of defecography and physiologic findings in male patients with rectocele[J]．Tech Coloproctol，2001，5(3)：157-161．.
6.	Liu J，Zhai LD，Li YS，et al．Measuring the space between vagina and rectum as it relates to rectocele[J]．World J Gastroenterol，2009，15(24)：3051-3054．.
7.	Zhang B，Ding JH，Yin SH，et al．Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception[J]．World J Gastroenterol，2010， 16(20)：2542-2548．.
8.	Gravié JF，Lehur PA，Huten N，et al．Stapled hemorrhoidopexy versus Milligan-Morgan hemorrhoidectomy：a prospective， randomized，multicenter trial with 2-year ostoperative follow up[J]. Ann Surg，2005，242(1)：29-35．.
9.	Grassi R，Romano S，Micera O，et al．Radiographic findings of post-operative double stapled trans anal rectal resection (STARR) in patient with obstructed defecation syndrome (ODS)[J]．Eur J Radiol，2005，53(3)：410-416．.
10.	Zimmernlan CW．Posterior vaginal reconstruction using uterosacral colpopexy：the new posterior repairs[C]．Beijing：The first Sino-American meeting of pelvic reconstructive and gynecologic surgeries，2005：196．.
11.	Satish SR，Kimberly DW，Leistikow JS．Obstructive defecation：a failure of rectoanal coordination[J]．Am J Gastroenterol， 1998，93(7)：1042-1050．.
12.	吴阶平，裘法祖．黄家驷外科学[ M]．北京：人民卫生出版社， 2000：1188-1189．.
13.	Mellgren A，Anzén B，Nilsson BY，et al．Results of rectocele repair．A prospective study[J]．Dis Colon Rectum，1995， 38(1)：7-13．.
14.	Murthy VK，Orkin BA，Smith LE，et al．Excellent outcome using selective criteria for rectocele repair[J]．Dis Colon Rectum， 1996，39(4)：374-378．.
15.	韩少良，倪士昌．大肠肛门疾病外科治疗[ M]．北京：人民军医出版社，2006：487-526．.
16.	喻德洪．现代肛肠外科学[ M]．北京：人民军医出版社， 1997：477-478．.
17.	Block IR．Transrectal repair of rectocele using obliterative suture[J]．Dis Colon Rectum，1986，29(11)：707-711．.
18.	van Dam JH，Ginai AZ，Gosselink MJ，et al．Role of defecography in predicting clinical outcome of rectocele repair[J]．Dis Colon Rectum，1997，40(2)：201-207．.
19.	de Tayrac R，Picone O，Chauveaud-Lambling A，et al．A 2-year anatomical and functional assessment of transvaginal rectocele repair using a polypropylene mesh[J]．Int Urogynecol J Pelvic Floor Dysfunct，2006，17(2)：100-105．.
20.	Yamana T，Takahashi T，Iwadare J．Clinical and physiologic outcomes after transvaginal rectocele repair[J]．Dis Colon Rectum，2006，49(5)：661-667．.
21.	Schwandner O，Stuto A，Jayne D，et al．Decision-making algorithm for the STARR procedure in obstructed defecation syndrome：position statement of the group of STARR Pioneers[J]． Surg Innov，2008，15(2)：105-109．.
22.	Lenisa L，Schwandner O，Stuto A，et al．STARR with contour transtar：prospective multicentre European study[J]．Colorectal Dis，2009，11(8)：821-827．.
23.	Longo A．Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular stapling device：a new procedure[C]．Rome，Italy：Proceedings of the 6th World Congress of Endoscopic Surgery，1998：777-784．.
24.	Laughlan K，Jayne DG，Jackson D，et al．Stapled haemorrhoidopexy compared to Milligan-Morgan and Ferguson haemorrhoidectomy：a systematic review[J]．Int J Colorectal Dis，2009， 24(3)：335-344．.
25.	Burch J，Epstein D，Baba-Akbari A，et al．Stapled haemorrhoidectomy (haemorrhoidopexy) for the treatment of haemorrhoids：a systematic review and economic evaluation[J]．Health Technol Assess，2008，12(8)：iii-iv，ix-x，1-193．.
26.	Farouk R，Bhardwaj R，Phillips RK．Stapled transanal resection of the rectum (STARR) for the obstructed defaecation syndrome[J]．Ann R Coll Surg Engl，2009，91(4)：287-291．.
27.	Regadas FS，Regadas SM，Rodrigues LV，et al．Transanal repair of rectocele and full rectal mucosectomy with one circular stapler：a novel surgical technique[J]．Tech Coloproctol，2005， 9(1)：63-66．.
28.	Altomare DF，Rinaldi M，Veglia A，et al．Combined perineal and endorectal repair of rectocele by circular stapler：a novel surgical technique[J]．Dis Colon Rectum，2002，45(11)：15491552．.
29.	梁德森，刘昶，潘尚哈，等．吻合器直肠黏膜环形切除联合经直肠闭式修补术在直肠前突中的应用[ J]．中华普通外科杂志， 2004，19(9)：577-578．.
30.	Pigot F，Dao-Quang M，Castinel A，et al．Low hemorrhoidopexy staple line does not improve results and increases risk for incontinence[J]．Tech Coloproctol，2006，10(4)：329-333．.
31.	Mongardini M，Pappalardo G．The use of Floseal in the prevention and treatment of intra- and post-operative hemorrhage in the surgical treatment of hemorrhoids and colporectocele．Preliminary results[J]．G Chir，2003，24(10）：377-381．.

1. 尹淑慧，赵克，侯庆香，等．吻合器经肛直肠切除术与经阴道手术治疗直肠前突的比较[ J]．中国普外基础与临床杂志， 2010，17(2)：129-132．.
2. Dietz H．Rectocele or stool quality：what matters more for symptoms of obstructed defecation?[J]．Tech Coloproctol，2009， 13(4)：265-268．.
3. Renzi A，Izzo D，Di Sarno G，et al．Stapled transanal rectal resection to treat obstructed defecation caused by rectal intussusception and rectocele[J]．Int J Colorectal Dis，2006，21(7)：661667．.
4. Boccasanta P，Venturi M，Stuto A，et al．Stapled transanal rectal resection for outlet obstruction：a prospective，multicenter trial[J]．Dis Colon Rectum，2004，47(8)：1285-1297．.
5. Chen HH，Iroatulam A，Alabaz O，et al．Associations of defecography and physiologic findings in male patients with rectocele[J]．Tech Coloproctol，2001，5(3)：157-161．.
6. Liu J，Zhai LD，Li YS，et al．Measuring the space between vagina and rectum as it relates to rectocele[J]．World J Gastroenterol，2009，15(24)：3051-3054．.
7. Zhang B，Ding JH，Yin SH，et al．Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception[J]．World J Gastroenterol，2010， 16(20)：2542-2548．.
8. Gravié JF，Lehur PA，Huten N，et al．Stapled hemorrhoidopexy versus Milligan-Morgan hemorrhoidectomy：a prospective， randomized，multicenter trial with 2-year ostoperative follow up[J]. Ann Surg，2005，242(1)：29-35．.
9. Grassi R，Romano S，Micera O，et al．Radiographic findings of post-operative double stapled trans anal rectal resection (STARR) in patient with obstructed defecation syndrome (ODS)[J]．Eur J Radiol，2005，53(3)：410-416．.
10. Zimmernlan CW．Posterior vaginal reconstruction using uterosacral colpopexy：the new posterior repairs[C]．Beijing：The first Sino-American meeting of pelvic reconstructive and gynecologic surgeries，2005：196．.
11. Satish SR，Kimberly DW，Leistikow JS．Obstructive defecation：a failure of rectoanal coordination[J]．Am J Gastroenterol， 1998，93(7)：1042-1050．.
12. 吴阶平，裘法祖．黄家驷外科学[ M]．北京：人民卫生出版社， 2000：1188-1189．.
13. Mellgren A，Anzén B，Nilsson BY，et al．Results of rectocele repair．A prospective study[J]．Dis Colon Rectum，1995， 38(1)：7-13．.
14. Murthy VK，Orkin BA，Smith LE，et al．Excellent outcome using selective criteria for rectocele repair[J]．Dis Colon Rectum， 1996，39(4)：374-378．.
15. 韩少良，倪士昌．大肠肛门疾病外科治疗[ M]．北京：人民军医出版社，2006：487-526．.
16. 喻德洪．现代肛肠外科学[ M]．北京：人民军医出版社， 1997：477-478．.
17. Block IR．Transrectal repair of rectocele using obliterative suture[J]．Dis Colon Rectum，1986，29(11)：707-711．.
18. van Dam JH，Ginai AZ，Gosselink MJ，et al．Role of defecography in predicting clinical outcome of rectocele repair[J]．Dis Colon Rectum，1997，40(2)：201-207．.
19. de Tayrac R，Picone O，Chauveaud-Lambling A，et al．A 2-year anatomical and functional assessment of transvaginal rectocele repair using a polypropylene mesh[J]．Int Urogynecol J Pelvic Floor Dysfunct，2006，17(2)：100-105．.
20. Yamana T，Takahashi T，Iwadare J．Clinical and physiologic outcomes after transvaginal rectocele repair[J]．Dis Colon Rectum，2006，49(5)：661-667．.
21. Schwandner O，Stuto A，Jayne D，et al．Decision-making algorithm for the STARR procedure in obstructed defecation syndrome：position statement of the group of STARR Pioneers[J]． Surg Innov，2008，15(2)：105-109．.
22. Lenisa L，Schwandner O，Stuto A，et al．STARR with contour transtar：prospective multicentre European study[J]．Colorectal Dis，2009，11(8)：821-827．.
23. Longo A．Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular stapling device：a new procedure[C]．Rome，Italy：Proceedings of the 6th World Congress of Endoscopic Surgery，1998：777-784．.
24. Laughlan K，Jayne DG，Jackson D，et al．Stapled haemorrhoidopexy compared to Milligan-Morgan and Ferguson haemorrhoidectomy：a systematic review[J]．Int J Colorectal Dis，2009， 24(3)：335-344．.
25. Burch J，Epstein D，Baba-Akbari A，et al．Stapled haemorrhoidectomy (haemorrhoidopexy) for the treatment of haemorrhoids：a systematic review and economic evaluation[J]．Health Technol Assess，2008，12(8)：iii-iv，ix-x，1-193．.
26. Farouk R，Bhardwaj R，Phillips RK．Stapled transanal resection of the rectum (STARR) for the obstructed defaecation syndrome[J]．Ann R Coll Surg Engl，2009，91(4)：287-291．.
27. Regadas FS，Regadas SM，Rodrigues LV，et al．Transanal repair of rectocele and full rectal mucosectomy with one circular stapler：a novel surgical technique[J]．Tech Coloproctol，2005， 9(1)：63-66．.
28. Altomare DF，Rinaldi M，Veglia A，et al．Combined perineal and endorectal repair of rectocele by circular stapler：a novel surgical technique[J]．Dis Colon Rectum，2002，45(11)：15491552．.
29. 梁德森，刘昶，潘尚哈，等．吻合器直肠黏膜环形切除联合经直肠闭式修补术在直肠前突中的应用[ J]．中华普通外科杂志， 2004，19(9)：577-578．.
30. Pigot F，Dao-Quang M，Castinel A，et al．Low hemorrhoidopexy staple line does not improve results and increases risk for incontinence[J]．Tech Coloproctol，2006，10(4)：329-333．.
31. Mongardini M，Pappalardo G．The use of Floseal in the prevention and treatment of intra- and post-operative hemorrhage in the surgical treatment of hemorrhoids and colporectocele．Preliminary results[J]．G Chir，2003，24(10）：377-381．.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of Procedure for Prolapse and Hemorrhoids and Block Repair Procedure in Treatment for Rectocele

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