TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler). A prospective multicenter trial

Cruz, José Vinicius; Regadas, Francisco Sergio P.; Murad-Regadas, Sthela Maria; Rodrigues, Lusmar Veras; Benicio, Fernando; Leal, Rogério; Carvalho, César G.; Fernandes, Margarete; Roche, Lucimar M. C.; Miranda, Antônio Carlos; Câmara, Lucia; Pereira, Joaquim Costa; Parra, Antonio Mallén; Leal, Vilmar Moura

TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler). A prospective multicenter trial

CONTEXT: Since anorectocele is usually associated with mucosa prolapse and/or rectal intussusceptions, it was developed a stapled surgical technique using one circular stapler. OBJECTIVE: To report the results of Transanal Repair of Rectocele and Rectal Mucosectomy with one Circular Stapler (TRREMS...

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Autores:	Cruz, José Vinicius, Regadas, Francisco Sergio P., Murad-Regadas, Sthela Maria, Rodrigues, Lusmar Veras, Benicio, Fernando, Leal, Rogério, Carvalho, César G., Fernandes, Margarete, Roche, Lucimar M. C., Miranda, Antônio Carlos, Câmara, Lucia, Pereira, Joaquim Costa, Parra, Antonio Mallén, Leal, Vilmar Moura
Formato:	artículo
Estado:	Versión publicada
Fecha de publicación:	2011
País:	Brasil
Recursos:	Universidade Federal do Ceará (UFC)
Repositorio:	Repositório Institucional da Universidade Federal do Ceará (UFC)
Idioma:	inglés
OAI Identifier:	oai:repositorio.ufc.br:riufc/18125
Acesso em linha:	http://www.repositorio.ufc.br/handle/riufc/18125
Access Level:	acceso abierto
Palavra-chave:	Retocele Mucosa Intestinal Prolapso Retal

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network_name_str	Brasil
repository_id_str
dc.title.pt_BR.fl_str_mv	TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler). A prospective multicenter trial
title	TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler). A prospective multicenter trial
spellingShingle	TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler). A prospective multicenter trial Cruz, José Vinicius Retocele Mucosa Intestinal Prolapso Retal
title_short	TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler). A prospective multicenter trial
title_full	TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler). A prospective multicenter trial
title_fullStr	TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler). A prospective multicenter trial
title_full_unstemmed	TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler). A prospective multicenter trial
title_sort	TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler). A prospective multicenter trial
dc.creator.none.fl_str_mv	Cruz, José Vinicius Regadas, Francisco Sergio P. Murad-Regadas, Sthela Maria Rodrigues, Lusmar Veras Benicio, Fernando Leal, Rogério Carvalho, César G. Fernandes, Margarete Roche, Lucimar M. C. Miranda, Antônio Carlos Câmara, Lucia Pereira, Joaquim Costa Parra, Antonio Mallén Leal, Vilmar Moura
author	Cruz, José Vinicius
author_facet	Cruz, José Vinicius Regadas, Francisco Sergio P. Murad-Regadas, Sthela Maria Rodrigues, Lusmar Veras Benicio, Fernando Leal, Rogério Carvalho, César G. Fernandes, Margarete Roche, Lucimar M. C. Miranda, Antônio Carlos Câmara, Lucia Pereira, Joaquim Costa Parra, Antonio Mallén Leal, Vilmar Moura
author_role	author
author2	Regadas, Francisco Sergio P. Murad-Regadas, Sthela Maria Rodrigues, Lusmar Veras Benicio, Fernando Leal, Rogério Carvalho, César G. Fernandes, Margarete Roche, Lucimar M. C. Miranda, Antônio Carlos Câmara, Lucia Pereira, Joaquim Costa Parra, Antonio Mallén Leal, Vilmar Moura
author2_role	author author author author author author author author author author author author author
dc.subject.por.fl_str_mv	Retocele Mucosa Intestinal Prolapso Retal
topic	Retocele Mucosa Intestinal Prolapso Retal
description	CONTEXT: Since anorectocele is usually associated with mucosa prolapse and/or rectal intussusceptions, it was developed a stapled surgical technique using one circular stapler. OBJECTIVE: To report the results of Transanal Repair of Rectocele and Rectal Mucosectomy with one Circular Stapler (TRREMS procedure) in the treatment of anorectocele with mucosa prolapse in a prospective multicenter trial. METHODS: It was conducted by 14 surgeons and included 75 female patients, mean aged 49.6 years, with symptoms of obstructed defecation due to grade 2 (26.7%) and grade 3 (73.3%) anorectocele associated with mucosa prolapse and/or rectal intussusception (52.0%) and an average validated Wexner constipation score of 16. All patients were evaluated by a proctological examination, cinedefecography, anal manometry and colonic transit time. The TRREMS procedure consists of the manual removal of the rectocele wall with circumferential rectal mucosectomy performed with a circular stapler. The mean follow-up time was 21 months. RESULTS: All patients presented obstructed defecation and they persisted with symptoms despite conservative treatment. The mean operative time was 42 minutes. In 13 (17.3%) patients, bleeding from the stapled line required hemostatic suture. Stapling was incomplete in 2 (2.6%). Forty-nine patients (65.3%) required 1 hospitalization day, the remainder (34.7%) 2 days. Postoperatively, 3 (4.0%) patients complained of persistent rectal pain and 7 (9.3%) developed stricture on the stapled suture subsequently treated by stricturectomy under anesthesia (n = 1), endoscopic stricturectomy with hot biopsy forceps (n = 3) and digital dilatation (n = 3). Postoperative cinedefecography showed residual grade I anorectoceles in 8 (10.6%). The mean Wexner constipation score decreased significantly from 16 to 4 (0-4: n = 68) (6: n = 6) (7: n = 1) (P<0.0001). CONCLUSION: Current trial results suggest that TRREMS procedure is a safe and effective technique for the treatment of anorectocele associated with mucosa prolapse. The stapling technique is low-cost as requires the use of a single circular stapler.
publishDate	2011
dc.date.issued.fl_str_mv	2011-01
dc.date.accessioned.fl_str_mv	2016-07-04T12:38:10Z
dc.date.available.fl_str_mv	2016-07-04T12:38:10Z
dc.type.status.fl_str_mv	info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv	info:eu-repo/semantics/article
format	article
status_str	publishedVersion
dc.identifier.citation.fl_str_mv	CRUZ, J. V. et al. TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler). A prospective multicenter trial. Arq. Gastroenterol., São Paulo, v.48 n.1, jan./mar. 2011.
dc.identifier.uri.fl_str_mv	http://www.repositorio.ufc.br/handle/riufc/18125
dc.identifier.issn.none.fl_str_mv	0004-2803
identifier_str_mv	CRUZ, J. V. et al. TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler). A prospective multicenter trial. Arq. Gastroenterol., São Paulo, v.48 n.1, jan./mar. 2011. 0004-2803
url	http://www.repositorio.ufc.br/handle/riufc/18125
dc.language.iso.fl_str_mv	eng
language	eng
dc.rights.driver.fl_str_mv	info:eu-repo/semantics/openAccess
eu_rights_str_mv	openAccess
dc.publisher.none.fl_str_mv	Arquivos de Gastroenterologia
publisher.none.fl_str_mv	Arquivos de Gastroenterologia
dc.source.none.fl_str_mv	reponame:Repositório Institucional da Universidade Federal do Ceará (UFC) instname:Universidade Federal do Ceará (UFC) instacron:UFC
instname_str	Universidade Federal do Ceará (UFC)
instacron_str	UFC
institution	UFC
reponame_str	Repositório Institucional da Universidade Federal do Ceará (UFC)
collection	Repositório Institucional da Universidade Federal do Ceará (UFC)
bitstream.url.fl_str_mv	http://repositorio.ufc.br/bitstream/riufc/18125/2/license.txt http://repositorio.ufc.br/bitstream/riufc/18125/1/2011_art_jvcruz.pdf
bitstream.checksum.fl_str_mv	8a4605be74aa9ea9d79846c1fba20a33 e5c186c3465f01a24884660e5cffe103
bitstream.checksumAlgorithm.fl_str_mv	MD5 MD5
repository.name.fl_str_mv	Repositório Institucional da Universidade Federal do Ceará (UFC) - Universidade Federal do Ceará (UFC)
repository.mail.fl_str_mv	bu@ufc.br \|\| repositorio@ufc.br
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spelling	2016-07-04T12:38:10Z2016-07-04T12:38:10Z2011-01CRUZ, J. V. et al. TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler). A prospective multicenter trial. Arq. Gastroenterol., São Paulo, v.48 n.1, jan./mar. 2011.0004-2803http://www.repositorio.ufc.br/handle/riufc/18125CONTEXT: Since anorectocele is usually associated with mucosa prolapse and/or rectal intussusceptions, it was developed a stapled surgical technique using one circular stapler. OBJECTIVE: To report the results of Transanal Repair of Rectocele and Rectal Mucosectomy with one Circular Stapler (TRREMS procedure) in the treatment of anorectocele with mucosa prolapse in a prospective multicenter trial. METHODS: It was conducted by 14 surgeons and included 75 female patients, mean aged 49.6 years, with symptoms of obstructed defecation due to grade 2 (26.7%) and grade 3 (73.3%) anorectocele associated with mucosa prolapse and/or rectal intussusception (52.0%) and an average validated Wexner constipation score of 16. All patients were evaluated by a proctological examination, cinedefecography, anal manometry and colonic transit time. The TRREMS procedure consists of the manual removal of the rectocele wall with circumferential rectal mucosectomy performed with a circular stapler. The mean follow-up time was 21 months. RESULTS: All patients presented obstructed defecation and they persisted with symptoms despite conservative treatment. The mean operative time was 42 minutes. In 13 (17.3%) patients, bleeding from the stapled line required hemostatic suture. Stapling was incomplete in 2 (2.6%). Forty-nine patients (65.3%) required 1 hospitalization day, the remainder (34.7%) 2 days. Postoperatively, 3 (4.0%) patients complained of persistent rectal pain and 7 (9.3%) developed stricture on the stapled suture subsequently treated by stricturectomy under anesthesia (n = 1), endoscopic stricturectomy with hot biopsy forceps (n = 3) and digital dilatation (n = 3). Postoperative cinedefecography showed residual grade I anorectoceles in 8 (10.6%). The mean Wexner constipation score decreased significantly from 16 to 4 (0-4: n = 68) (6: n = 6) (7: n = 1) (P<0.0001). CONCLUSION: Current trial results suggest that TRREMS procedure is a safe and effective technique for the treatment of anorectocele associated with mucosa prolapse. The stapling technique is low-cost as requires the use of a single circular stapler.CONTEXTO: Como a anoretocele está sempre associada a prolapso mucoso e/ou intussuscepção retal, foi desenvolvida uma técnica cirúrgica grampeada, utilizando somente um grampeador mecânico. OBJETIVO: Demonstrar os resultados do estudo multicêntrico que realizou o tratamento cirúrgico de pacientes com anorretocele associado a prolapso mucoso, utilizando o reparo transanal da retocele e mucosectomia com grampeador circular mecânico. MÉTODO: Foram incluídos 75 pacientes, média de idade 49,6 anos, com sintomas de evacuação obstruída, apresentando escore médio de constipação de Wexner de 16 e diagnóstico de anorretocele grau II (26.7%), grau III (73,3%) associado a prolapso mucoso e intussuscepção (52%). Todos foram avaliados com exame proctológico, defecografia, manometria anorretal e tempo de trânsito colônico. O procedimento cirúrgico foi realizado por 14 cirurgiões e consiste na remoção manual da parede do reto no local da retocele e mucosectomia circunferencial com um grampeador circular mecânico. O seguimento médio foi de 21 meses. RESULTADOS: Os pacientes apresentavam sintomas de evacuação obstruída, mesmo após tratamento clinico. O tempo operatório médio foi de 42 minutos. Houve sangramento transanal na linha de sutura em 13 (17,3%) pacientes, sutura grampeada incompleta em 2 (2,6%) e dor retal persistente em 3 (4,0%). O tempo médio de internação hospitalar foi de 1 dia em 49 (65,3%) e 2 dias em 34,7%. Ocorreu redução na linha de sutura em 7 (9,3%), sendo necessário estricturotomia cirúrgica sob anestesia (n = 1), utilizando "hot biopsy" (n = 3) e dilatação anal (3). Defecografia no pós-operatório demonstrou anorretocele residual grau I em 8 (10.6%). O escore de constipação de Wexner reduziu 16 para 4 (0-4: n = 68) (6: n = 6) (7: n = 1) (P<0.0001). CONCLUSÃO: O resultado do estudo multicêntrico demonstrou que a técnica cirúrgica apresentada é segura e efetiva para tratamento da anorretocele associada a prolapso mucoso. Apresenta baixo custo pois utiliza um grampeador circular mecânico.Arquivos de GastroenterologiaRetoceleMucosa IntestinalProlapso RetalTRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler). A prospective multicenter trialinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleengreponame:Repositório Institucional da Universidade Federal do Ceará (UFC)instname:Universidade Federal do Ceará (UFC)instacron:UFCinfo:eu-repo/semantics/openAccessCruz, José ViniciusRegadas, Francisco Sergio P.Murad-Regadas, Sthela MariaRodrigues, Lusmar VerasBenicio, FernandoLeal, RogérioCarvalho, César G.Fernandes, MargareteRoche, Lucimar M. C.Miranda, Antônio CarlosCâmara, LuciaPereira, Joaquim CostaParra, Antonio MallénLeal, Vilmar MouraLICENSElicense.txtlicense.txttext/plain; charset=utf-81748http://repositorio.ufc.br/bitstream/riufc/18125/2/license.txt8a4605be74aa9ea9d79846c1fba20a33MD52ORIGINAL2011_art_jvcruz.pdf2011_art_jvcruz.pdfapplication/pdf383228http://repositorio.ufc.br/bitstream/riufc/18125/1/2011_art_jvcruz.pdfe5c186c3465f01a24884660e5cffe103MD51riufc/181252018-12-17 08:16:21.245oai:repositorio.ufc.br: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Repositório InstitucionalPUBhttp://www.repositorio.ufc.br/ri-oai/requestbu@ufc.br \|\| repositorio@ufc.bropendoar:2018-12-17T11:16:21Repositório Institucional da Universidade Federal do Ceará (UFC) - Universidade Federal do Ceará (UFC)false
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TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler). A prospective multicenter trial

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