Year 2013 Vol. 21 No 1

GENERAL AND SPECIAL SURGERY

B.N. ZHUKOV, V.R. ISAEV, A.V. ZHURAVLEV, A.A. CHERNOV, S.E. KATORKIN

EXPERIENCE OF CIRCULAR RESECTION OF THE MUCO- SUBMUCOSAL LAYER OF THE RECTAL LOWER AMPULLAR SECTION IN TREATMENT OF PATIENTS WITH RECTOCELE IN COMBINATION WITH CHRONIC INTERNAL HEMORRHOIDS OF 3-4 STAGE

SBEE HPE Samara State Medical University,
The Russian Federation

Objectives. To evaluate the treatment results of patients suffering from rectocele in combination with the chronic internal hemorrhoids after the circular endorectal resection of the muco-submucosal layer of the distal colon section.
Methods. The analysis of the surgical treatment results of 358 patients suffering from the chronic rectocele and chronic internal hemorrhoids who underwent the circular endorectal resection of the muco-submucosal layer of the distal colon section by A. Longo method was conducted. 3 subgroups of patients were formed: I patients with rectocele in combination with the chronic internal hemorrhoids; II females with rectocele without the chronic hemorrhoids; III patients of both sexes suffering from the chronic internal hemorrhoids.
Rectoromanoscopy, sphincterometry, profilometry, irrigoscopy with defecography, transrectal and transvaginal ultrasound examination were applied. Standard surgical sets were used while carrying out the operations.
During early postoperative period dynamics and intensity of the pain syndrome were evaluated, complications were analyzed. Long-term treatment results were studied in 252 patients (70,4%). The number of recurrences was analyzed and defecography was performed.
Results. Postoperative complications (hemorrhage, urinary retention, external hemorrhoids nodules edema) developed in 37 patients (7,5%). Long-term analysis revealed the A. Longo method of operation in case of combination of rectocele and the chronic internal hemorrhoids permitted to achieve good and satisfactory results in 98,8% of patients.
Conclusions. The advantages of the circular resection method of the colonic submucosal layer in case of combination of rectocele and the chronic internal hemorrhoids are the followings: low incidence of trauma, the lack of significant pain syndrome in the postoperative period, shortening of hospitalization period as well as of medical and social rehabilitation terms. The method permits to eliminate the redundant mucosal prolapse, to remove rectocele and at the same time to make a strong connective muscular frame along the colon anterior wall.

Keywords: hemorrhoids, rectocele, Longo method of operation, hemorrhoidectomy
p. 58 63 of the original issue
References
  1. Vorob'ev GI. Osnovy koloproktologii: ucheb. posobie [Fundamentals of oloproctology: a textbook]. Rostov na Don, RF: Feniks; 2001. 412 p.
  2. Fedorov VD, Dul'tsev IuV. Proktologiia [Proctology]. Moscow, RF: Meditsina; 1984. 384 p.
  3. Tjandra JJ, Ooi BS, Tang CL, Dwyer P, Carey M. Transanal repair of rectocele corrects obstructed defecation if it is not associated with anismus. Dis Colon Rectum. 1999 Dec;42(12):154450.
  4. Van Laarhoven CJ, Kamm MA, Bartram CI, Halligan S, Hawley PR, Phillips RK. Relationship between anatomic and symptomatic long-term results after rectocele repair for impaired defecation. Dis Colon Rectum. 1999 Feb;42(2):20410.
  5. Kiff ES, Swash M. Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence. Br J Surg. 1984 Aug;71(8):61416.
  6. Zhukov BN, Isaev VR, Chernov AA. Osnovy koloproktologii dlia vracha obshchei praktiki: monografiia [Fundamentals of oloproctology for general practitioners: a monograph]. Samara, RF: Ofort; 2009. 218 p.
  7. Boccasanta P, Venturi M, Calabro G, Trompetto M, Ganio E, Tessera G, Bottini C, Pulvirenti D'Urso A, Ayabaca S, Pescatori M. Which surgical approach for rectocele? A multicentric report from Italian coloproctologists. Tech Coloproctol. 2001 Dec;5(3):14956.
  8. Kuz'minov A.M., Chubarov Iu.Iu., Tikhonov A.A., Minbaev Sh.T., Korolik V.Iu. Otdalennye rezul'taty tsirkuliarnoi slizisto-podslizistoi rezektsii nizhneampuliarnogo otdela priamoi kishki pri lechenii gemorroia [Long-term results of the circular muco-submucosal resection of lower ampullary segment
  9. of the rectum during treatment of hemorrhoids]. Koloproktologiia. 2008;(1):48.
  10. Zhukov BN, Isaev VR, Chernov AA, Shamin AB, Zhuravlev AB. Maloinvazivnye tekhnologii v khirurgicheskom lechenii bol'nykh pri sochetanii rektotsele i gemorroia [Minimally invasive technology in the surgical treatment of patients with a combination of rectocele and hemorrhoids]. Samar Med Zhurn. 2008;43(3):2123.
  11. Zhukov BN, Isaev VR, Chernov AA, Zhuravlev AB. Sochetannoe khirurgicheskoe lechenie bol'nykh pri rektotsele i gemorroe [Combined surgical treatment of patients with rectocele and hemorrhoids]. Koloproktologiia. 2009;(1):1820.
  12. Aminev AM. Rukovodstvo po proktologii: v 4 t. [A guideline on proctology: 4 vol]. Kuibyshev, RF: Kn izd-vo; 1979;4. 560 p.
  13. DeLancey JO. Structural anatomy of the posterior pelvic compartment as it relates to rectocele. Am J Obstet Gynecol. 1999 Apr;180(4):81523.
  14. Doshchinin KV, Karamyshev A.S. Neposredstvennye i otdalennye rezul'taty operatsii Longo [The immediate and late results of the Longo's operation]. Koloproktologiia. 2010;(1):1318.
  15. Longo A. Treatment of haemorrhoids disease by reduction of mucosa and haemorrhoidal prolapse with a circular suturing device: a new procedure. Proceedings of the 6th World Congress of Endoscopic Surgery. Rome, IT: Monduzzi Editore, Bologna; 1998:77784.
  16. Vorob"ev GI. Osnovy koloproktologii [Fundamentals of coloproctology]. Moscow, RF: Med inform agentstvo; 2006. 432 p.
Address for correspondence:
443079, Rossiiskaia Federatsiia, g. Samara, pr. Karla Marksa, d. 165 b, Kliniki Samarskogo gosudarstvennogo meditsinskogo universiteta, kafedra i klinika gospital'noi khirurgii,
e-mail: katorkinse@mail.ru,
Katorkin Sergei Evgen'evich
Information about the authors:
Zhukov B.N. Honored Worker of science of RF, MD, professor, head of the chair and clinic of the hospital surgery of SBEE HPE Samara State Medical University.
Isaev V.R. MD, professor of the chair and clinic of the hospital surgery of SBEE HPE Samara State Medical University, chief freelance coloproctologist of MHC of Samara region.
Zhuravlev A.V. PhD, assistant of the chair and clinic of the hospital surgery of SBEE HPE Samara State Medical University.
Chernov A.A. PhD, head of the coloproctology department of the hospital surgery clinic of SBEE HPE Samara State Medical University.
Katorkin S.E. PhD, associate professor of the chair and clinic of the hospital surgery of SBEE HPE Samara State Medical University.
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