AvaliaÃÃo clÃnica e funcional no prà e pÃs-operatÃrio de pacientes portadoras de defecaÃÃo obstruÃda por retocele e prolapso mucoso retal, submetidas ao procedimento âtrremsâ. / Clinical and functional evaluation at the pre- and post operation of patients with obstructed defecation syndrome by rectocele and mucosa prolapsed treated by TRREMS procedure

AUTOR(ES)
FONTE

IBICT - Instituto Brasileiro de Informação em Ciência e Tecnologia

DATA DE PUBLICAÇÃO

13/11/2009

RESUMO

Obstructed defecation syndrome (ODS) can be induced by functional changes (anismus) or anatomical abnormalities, especially rectocele and rectal mucosal prolapse (RMP). Several surgical techniques with transvaginal, perineal or transanal access have been used in the treatment of rectocele. The first two are more commonly used by gynecologists, the last one is favored by proctologists. Depending on the prevalence of symptoms, patients may go to either specialist with the same result. The objective of the present study was to make a clinical and functional evaluation of patients submitted to the TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with a single circular stapler) as treatment for ODS caused by rectocele and RMP. The study included 35 female patients (34 of whom multiparous) aged 47.5Â10.83 years (31â67) diagnosed with ODS caused by RMP-associated rectocele grade II (n=13; 37.1%) or grade III (n=22; 62.9%). The study parameters included SDO and constipation scores, functional continence index, sexual function and treatment outcome satisfaction and pre- and postoperative defecographic measures. The average preoperative ODS score (10.63) was significantly reduced after surgery (2.91) (p=0.000). The average constipation score fell from 15.23 to 4.46 (p=0.000). The average functional continence score decreased from 2.77 to 1.71 (p=0.000). Between the first and the eighth postoperative day, the average visual analog scale pain score fell from 5.23 to 1.20 (p=0.000). Using the same scale, satisfaction with the treatment outcome was 79.97, 86.54, 87.65 and 88.06 at 1, 3, 6 and 12 months, respectively, and the average sexual function satisfaction was 42.91 (19â70) and 70.41 (39â97) before and after surgery, respectively (p=0.000). On defecography, average reductions in rectocele size were from 19.23Â8.84 mm (3â42) to 6.68Â3.65 mm (0â17) at rest and from 34.89Â12.30 mm (20â70) to 10.94Â5.97 mm (0â25) during evacuation (both p=0.000). The TRREMS procedure is a safe, efficient technique associated with satisfactory anatomical and functional results and reduced levels of postoperative pain and complications.

ASSUNTO(S)

medicina ressecÃÃo retal grampeada tÃcnica cirÃrgica constipaÃÃo surgical technique. constipation. obstructed defecation syndrome. rectocele. rectal mucosal prolapse grampeadores cirÃrgicos sÃndrome de defecaÃÃo obstruÃda. retocele prolapso mucoso retal stapled rectal resection constipaÃÃo intestinal retocele

ACESSO AO ARTIGO

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