Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy.
Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.
Tech Coloproctol. 2021 Jul;25(7):879-886. doi: 10.1007/s10151-021-02467-y. Epub 2021 May 28.
There are many surgical treatments aimed at correcting internal mucosal prolapse and rectocele associated with obstructed defecation syndrome (ODS). Perineal procedures can be considered as first options in young men in whom an abdominal approach poses risks of sexual dysfunction and in selected women with isolated posterior compartment prolapse who failed conservative treatment. About 20 years ago, we described endorectal proctopexy (ERPP) also known as internal Delorme procedure. The aim of the present study was to describe, with attention to technical details and the aid of a video, the different steps of ERPP for the treatment of ODS. A retrospective analysis of our last 100 cases confirms our initial good results. Complications included suture line dehiscence with consequent stricture in four patients (4%). Bleeding occurred in four (4%) patients and was conservatively treated. Transient anal continence impairment consisting of urgency and soiling occurred in 12 (12%) and 6 (6%) patients, respectively. At 6-month follow-up the Cleveland Clinic Constipation Score and ODS score improved from a median preoperative value of 18.9 and 18.5 to 5 and 5, respectively (p < 0.0001). The mean follow-up was 36.05 ± 13.3 (range 12-58) months and anatomical recurrence rate was 6 (%). Due to its excellent safety profile and the ability to tailor the procedure to different disease presentations, we think that ERPP should be part of the basic armamentarium of all colorectal surgeons operating on the pelvic floor.
有许多旨在纠正与阻塞性排便综合征（ODS）相关的内部黏膜脱垂和直肠前突的手术治疗方法。会阴手术可被视为年轻男性的首选方法，因为腹部手术可能导致性功能障碍，对于经保守治疗失败的孤立性后盆腔脱垂的特定女性也是如此。大约 20 年前，我们描述了经直肠直肠固定术（ERPP），也称为内部 Delorme 手术。本研究旨在描述 ERPP 治疗 ODS 的不同步骤，并通过视频辅助详细介绍技术细节。对我们最近 100 例病例的回顾性分析证实了我们最初的良好结果。并发症包括 4 例患者（4%）缝线裂开导致的狭窄，4 例患者（4%）发生出血，采用保守治疗。12 例（12%）和 6 例（6%）患者分别出现短暂性肛门控便功能障碍，包括急迫感和污染。在 6 个月的随访中，克利夫兰诊所便秘评分和 ODS 评分分别从术前中位数 18.9 和 18.5 改善至 5 和 5（p<0.0001）。平均随访时间为 36.05±13.3（范围 12-58）个月，解剖学复发率为 6%。由于其出色的安全性和能够根据不同的疾病表现定制手术，我们认为 ERPP 应该成为所有在盆底手术的结直肠外科医生基本手术方法的一部分。
