Outcomes of a modified Bresler procedure for the treatment of rectocele with rectal intussusception

Qun Deng; Kai-Lin Yu; Zhi-Yong Liu; Zhong Shen; Ya-Hui Wang; Yong-Mao Song; Chang-Jian Wang; Xiao-Ping Xu; Jian-Wei Wang

doi:10.1093/gastro/goaa027

Outcomes of a modified Bresler procedure for the treatment of rectocele with rectal intussusception

Gastroenterol Rep (Oxf). 2020 Jul 4;8(6):457-464. doi: 10.1093/gastro/goaa027. eCollection 2020 Dec.

Authors

Qun Deng¹, Kai-Lin Yu², Zhi-Yong Liu³, Zhong Shen³, Ya-Hui Wang¹, Yong-Mao Song¹, Chang-Jian Wang³, Xiao-Ping Xu⁴, Jian-Wei Wang¹

Affiliations

¹ Department of Colorectal Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
² Department of Ultrasonography, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
³ Department of Anorectal Surgery, The Third People's Hospital of Hangzhou, Hangzhou, Zhejiang, China.
⁴ Department of Colorectal Surgery, The First People's Hospital of Yuhang District, Hangzhou, Zhejiang, China.

Abstract

Background: Obstructed defecation syndrome (ODS) is a condition that is frequently caused by rectocele and rectal intussusception. This study aimed to evaluate the effectiveness of a modified Bresler procedure for the treatment of ODS. The outcomes of this modified procedure were compared with the stapled transanal rectal resection (STARR) procedure.

Methods: We performed a retrospective analysis of the clinical data from 76 female patients who presented with ODS between June 2014 and June 2016. The patients were divided into two treatment groups, namely Modified and STARR. Patients in the Modified group (n = 36) underwent the modified Bresler procedure, which involved posterior rectal-wall resection using a circular tubular stapler with multilevel purse-string sutures. Patients in the STARR group (n = 40) underwent the standard STARR procedure. We analysed post-operative complications, Wexner constipation scores (WCS), rectocele depths, and four-point post-operative satisfaction scales.

Results: Patients in the Modified group exhibited shorter operative times and fewer post-operative complications (both P < 0.05). At 12 months post-operatively, both the Modified and STARR groups displayed a significant improvement in the Wexner constipation score and the depth of rectocele. The post-operative WCS for the Modified group were significantly improved compared to those for the STARR group (P < 0.05), while there was no significant difference in the rectocele depth between the two groups (P > 0.05). Post-operative interviews at post-operative 12 months showed that patients in the Modified group had a better satisfaction (P = 0.05).

Conclusions: Our modified procedure may be an effective treatment strategy for patients experiencing ODS caused by rectocele and rectal intussusception, with fewer complications and effective relief of symptoms.

Keywords: Bresler procedure; obstructed defecation obstructive constipation; rectal intussusception; rectocele; stapled transanal rectal resection.