Published online Mar 21, 2019. doi: 10.3748/wjg.v25.i11.1421
Peer-review started: January 30, 2019
First decision: February 13, 2019
Revised: February 17, 2019
Accepted: February 22, 2019
Article in press: February 22, 2019
Published online: March 21, 2019
Obstructed defecation syndrome (ODS) has a serious influence on health and life quality of patients. Rectocele is one of the main causes of ODS, which has an approximate incidence of 30%-71%. Multiple procedures have been performed to treat rectocele, but no one has been considered as the gold-standard treatment.
Stapled transanal rectal resection (STARR) has been quite popular in treating rectocele for its simpleness. However, debate on STARR has never stopped. Opponents doubted its effectiveness in anterior wall repair and declared that multiple serious postoperative complications occurred. Khubchandani performed his procedure for rectocele with a satisfying effect, but it did not take rectal prolapse into consideration and may potentially induce rectal prolapse in posterior rectal wall. Therefore, we combined Khubchandani’s procedure and stapled posterior rectal wall resection together.
In this study, we evaluated the efficacy and safety of a novel rectocele repair which combined Khubchandani’s procedure with stapled posterior rectal wall resection. The results of the study will guide the treatment for rectocele in future.
From January 2014 to January 2017, 93 patients were recruited into our randomized clinical trial and divided into two different groups in a randomized manner. Forty-two patients (group A) underwent Khubchandani’s procedure with stapled posterior rectal wall resection (KSPRWR) and 51 patients (group B) underwent the stapled transanal rectal resection (STARR) procedure. Follow-up was performed at 1, 3, 6, and 12 mo after the operation. Preoperative and postoperative ODS scores and depth of rectocele, postoperative complications, blood loss, and hospital stay of each patient were documented. All data were analyzed statistically to evaluate the efficiency and safety of our procedure.
No significant differences were found in blood loss, hospital stay, or operative time. Compared with preoperative ODS scores and rectocele depth, postoperative ODS scores and rectocele depth in the two groups were statistically lower, which proved the effectiveness of our procedure. There were significant differences when comparing the ODS score and rectocele depth 1 year after operation, which were significantly lower in group A than in group B, thus indicating that group A might have better outcomes in future.
KSPRWR is an effective and safe procedure with minor trauma, short hospital stay, and low cost for rectocele treatment, especially for rectocele combined with rectal prolapse. It should be considered as an alternative operation for rectocele.
A long-term follow-up, a larger number of patients, and a multiple center clinical trial are expected in the future to further prove the effectiveness and safety of this procedure.