STAPLED VAGINA SERIES

In step 2, we performed the procedure as reported by Khubchandani: 1:1000 adrenaline was injected into the mucosa of the anterior rectal wall to aid hemostasis.

The posterior rectal wall was resected as a half circle. The stapler was opened to its maximum and withdrawn. We then closed and fired the stapler and held it closed for 15 s to aid hemostasis. The stapler was adjusted until the half-purse string lay on the shaft of the stapler.

STAPLED VAGINA SERIES

We placed the anvil of the stapling instrument (EEA TM Auto Suture TM Hemorrhoid and Prolapse Stapler wit DST Series TM Technology, 3.3-3.5 mm) above the half-purse string and inserted a small intestinal spatula into the anus with the distant edge above the half-purse string to protect the anterior wall. Step 1 included performing stapled posterior rectal wall resection, as follows: We placed a circular anal dilator to loosen the anal canal and then inserted a half-purse string suture, which only included the mucosa and the submucosa, clockwise from 8 o’clock to 4 o’clock using a 2-0 absorbable suture at about 4 cm above the dentate line on the posterior wall of the anus. KSPRWR procedure: The patients received spinal anesthesia and were placed in the prone jackknife position. Other preoperative preparations included perioperative antibiotics and insertion of a urinary catheter. Preoperative procedure: An enema was administered the night before the surgery and another on the morning of the surgery. Our department developed a new procedure that combined Khubchandani’s procedure with stapled posterior rectal wall resection (KSPRWR) in 42 female patients with ODS caused by rectocele combined with or without rectal mucosal prolapse to evaluate and compare its safety and effectiveness with the STARR procedure. However, the STARR procedure still has its disadvantages, and no surgical technique has been widely adopted as the gold-standard procedure for treatment of rectocele, as well as rectocele combined with rectal prolapse. Several procedures for rectocele resection have been reported during the past years, and among them stapled transanal rectal resection (STARR) procedure was more often used. Approximately 54% of ODS patients suffer from both mucosal prolapse and rectocele. Although the incidence of rectocele is still illusive, approximately 30%-71% females suffer from the disease rectocele, pelvic floor disease, and rectal mucosal prolapse are the most common causes of ODS in approximately 80% of female patients. The etiology of ODS can be functional disorders or rectal anatomy abnormality such as rectocele with or without rectal prolapse. The symptoms, such as difficult evacuation, prolonged or infrequent defecation, sense of incomplete evacuation, difficult evacuation without hand assistance, and perineal heaviness, significantly lower the life quality of ODS patients. Obstructed defecation syndrome (ODS), which is more common in females, is one of the most widespread diseases in the world.

After 12 mo of follow-up, 30 patients’ (30/34, 88.2%) final outcomes were judged as effective and 4 (4/34, 11.8%) as moderate in group A, whereas in group B, 30 (30/37, 81.1%) patients’ outcomes were judged as effective, 5 (5/37, 13.5%) as moderate, and 2 (2/37, 5.4%) as poor. No other serious complications, such as rectovaginal fistula, perianal sepsis, or deaths, were recorded. Mean depth of rectocele decreased from 4.32 ± 0.96 cm (group A) vs 4.18 ± 0.95 cm (group B) preoperatively to 1.19 ± 0.43 cm (group A) vs 1.54 ± 0.82 cm (group B) one year after operation. Mean ODS score in group A declined from 16.50 ± 2.06 before operation to 5.06 ± 1.07 one year after the operation, whereas in group B it was 17.11 ± 2.57 before operation and 6.03 ± 2.63 one year after the operation. Mean hospital stay was 3.15 ± 0.70 d (group A) vs 3.14 ± 0.54 d (group B). Mean operative duration was 41.47 ± 6.43 min (group A) vs 39.24 ± 6.53 min (group B). In group B, 51 patients underwent the STARR procedure and 37 were followed until the final analysis. In group A, 42 patients underwent Khubchandani’s procedure with stapled posterior rectal wall resection and 34 were followed until the final analysis.

Stapled vagina