Mucopexy-Recto Anal Lifting (MuRAL) in managing obstructed defecation syndrome associated with prolapsed hemorrhoids and rectocele: preliminary results

Claudio Pagano; Marco Venturi; Guido Benegiamo; Ernesto Melada; Contardo Vergani

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저자정보: Claudio Pagano (Vizzolo Predabissi Hospital) Marco Venturi (Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico) Guido Benegiamo (Vizzolo Predabissi Hospital) Ernesto Melada (Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico) Contardo Vergani (Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico)

저널정보: 대한외과학회 Annals of Surgical Treatment and Research Annals of Surgical Treatment and Research Vol.98 No.5

발행연도: 2020.5

수록면: 277 - 282 (6page)

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Purpose: Treatment of rectocele associated with prolapsed hemorrhoids is a debated topic. Transanal stapling achieved good midterm results in patients with symptoms of obstructed defecation, nevertheless a number of severe complications have been reported. The aim of this study was to evaluate the safety and efficacy of a new endorectal manual technique in patients with obstructed defecation due to the combination of muco-hemorrhoidal prolapse and rectocele.
Methods: Patients enrolled after preoperative obstructed defecation syndrome (ODS) score, defecography and anoscopy were submitted to the novel Mucopexy-Recto Anal Lifting (MuRAL) combined with a modified Block procedure, and followed up by independent observers with digital exploration 3 weeks postoperatively, and digital exploration plus anoscopy at 3, 6, and 12 months. Operative time, hospital stay, numerating rating scale (NRS), ODS, satisfaction scores, and recurrence rate were recorded.
Results: Mean operative time was 35.7 minutes. Fifty-six patients completed 1-year follow-up: 7.1% had acute urinary retention, NRS score was < 3 from the third postoperative day, mean time of daily activity resumption was 12 days, none had persistent fecal urgency, 82% declared excellent/good satisfaction score, significant improvement of 6- and 12-month ODS score, no recurrence of rectocele, and 7.1% recurrence of prolapsed hemorrhoids were observed.
Conclusion: MuRAL associated with modified Block technique gave no severe complications and resulted in a safe and effective approach to symptomatic rectocele associated with muco-rectal prolapse. Further randomized studies, larger series, and longer follow-up are needed.

#Hemorrhoids #Intussusception #Rectal prolapse #Rectocele

참고문헌 (13)

참고문헌 신청

Boccasanta P / 2001 / Which surgical approach for rectocele? A multicentric report from Italian coloproctologists / Tech Coloproctol 5:149~156

Block IR / 1986 / Transrectal repair of rectocele using obliterative suture / Dis Colon Rectum 29:707~711

Tjandra JJ / 2007 / Systematic review on the procedure for prolapse and hemorrhoids(stapled hemorrhoidopexy) / Dis Colon Rectum 50:878~892

Guttadauro A / 2018 / Value and limits of stapled transanal rectal repair for obstructed defecation syndrome : 10years-experience with 450 cases / Asian J Surg 41:573~577

Pescatori M / 2008 / Postoperative complications after procedure for prolapsed hemorrhoids(PPH)and stapled transanal rectal resection(STARR)procedures / Tech Coloproctol 12:7~19

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