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The rectal pocket syndrome after stapled mucosectomy
M Pescatori1, M Spyrou, L Cobellis
1Coloproctology Units of Villa Flaminia Hospital, Rome, Italy. ucpclub@virgilio.it
Summary
Rectal pocket syndrome (RPS) is a rare complication after stapled rectal mucosectomy (SM). This condition, often caused by suture defects, can lead to pain and sepsis but is typically treatable with transanal surgery.
Area of Science:
- Colorectal Surgery
- Surgical Complications
- Gastrointestinal Procedures
Background:
- Stapled mucosectomy (SM) offers reduced postoperative pain compared to manual hemorrhoidectomy.
- Unusual complications following SM can necessitate further surgical intervention.
- Rectal pocket syndrome (RPS) is an uncommon postoperative complication requiring specific attention.
Purpose of the Study:
- To describe the clinical presentation and outcomes of patients experiencing rectal pocket syndrome (RPS) after stapled rectal mucosectomy (SM).
- To investigate the etiology and successful treatment modalities for RPS following SM.
Main Methods:
- Retrospective analysis of six patients (4 female, 2 male) who developed RPS post-SM.
- Clinical examination, proctoscopy, anal manometry, and ultrasound were utilized for diagnosis.
- Four patients underwent surgical reintervention for RPS.
Main Results:
- RPS presented as a painful intramucosal rectal pocket with an orifice at the suture line, often associated with entrapped fecal matter and chronic abscesses.
- Surgical treatment involved laying open and curetting the cavity; one patient required a fistulotomy.
- The overall incidence of RPS in the study units was 2.5%, with successful treatment in most cases after a mean follow-up of 25 months.
Conclusions:
- Rectal pocket syndrome (RPS) is a potential complication of stapled rectal mucosectomy (SM), likely resulting from suture line defects.
- Transanal surgical intervention, such as laying open the pocket, is an effective treatment for most RPS cases.
- Early recognition and management are crucial for favorable outcomes in patients with post-SM RPS.
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