[Sequential transfixed stitch technique (STST) in the treatment of rectocoele: advantages and efficiency in the first...

Rectocoele is defined as herniation of the anterior rectal and vaginal wall in the vaginal lumen due to the loss of recto-vaginal septum. Transvaginal and transanal surgical approaches are currently used for the definitive treatment of symptomatic rectocoele, with conflicting results. The authors report the results of a new surgical technique defined as the sequential transfixed stitch technique (STST) using a new anal retractor of their own design. A total of 20 patients with symptomatic rectocoele (grade II in 11 and grade III in 9), assessed by proctological evaluation, digital examination of the anal canal, sphere test, defecography and total colonoscopy, were submitted to STST. Patients with previous colorectal or pelvic surgery were excluded from the study. Quality of life was assessed using a questionnaire before surgery and at 3 and 6 months of follow-up. Data were evaluated using the Agachan-Wexner score. STST was correctly performed in all cases without any early or late complications. The mean quality of life score before the intervention was 28.5, as against 16.4 after 3 months and 15.9 after 6 months (p < 0.05). The surgical procedure with the new retractor was judged satisfactory in 80% of cases. STST yielded optimal results for the surgical treatment of symptomatic rectocoele in our experience with a significant improvement in quality of life referred by the patients and the absence of postoperative sphincter damage.