Giuliano Reboa1, Marco Gipponi2, Angelo Caviglia3, Joana Matos4, Maurizio Gallo5, Daniele Ferrari6. 1. Department of General Surgery, Coloproctology Unit, San Camillo Hospital, Forte dei Marmi, Lucca, Italy. 2. Department of General Surgery, Breast Unit, San Martino-IST IRCCS, Genoa, Italy marco.gipponi@hsanmartino.it. 3. Colo-Proctology Unit, San Camillo Hospital, Rome, Italy. 4. Advanced Center of Experimental Surgery (CCEA), Vila do Conde, Portugal. 5. Department of Oncology, San Martino-IST IRCCS, Genoa, Italy. 6. Department of Engineering, University of Rome, Rome, Italy.
Abstract
BACKGROUND/AIM: Standard stapled transanal rectal resection (STARR) with two PPH-01™ poses some questions regarding the completeness of prolapse resection in patients with obstructed defecation syndrome (ODS) since 20% to 30% of patients have persistent rectocele or rectal intussusception that may impair the physiological recovery of rectal sensitivity. New high-volume (HV) devices, such as CPH34 HV™ and CPH36 SMS™, allow for wider prolapsectomy to be performed and we herein assessed the possibility and safety of a STARR mono-stapler. MATERIALS AND METHODS: On May 30th-31st 2011, 13 pigs were selected to undergo standard STARR with two PPH-01™ (n=2) or STARR mono-stapler with one CPH34 HV™ (n=11) at the Experimental Center of Vila do Conde (Portugal); another set of 13 pigs was selected on January 14th-17th 2014 to undergo standard STARR (n=2) or STARR mono-stapler by means of one CPH36 SMS™ (n=11). The length, height, square surface, and volume of resected specimens were intra-operatively assessed. Pigs were monitored for three days before undergoing transrectal sonography and autopsy to check for locoregional complications. RESULTS: CPH36 SMS™ STARR mono-stapler achieved 57% higher volume of prolapsectomy compared to Standard STARR (p=0.008); moreover, surface measures of the specimens of CPH36 SMS™ STARR mono-stapler were significantly higher (length, p=0.003; height, p=0.004; square surface, p=0.002) compared to CPH34 HV™ STARR mono-stapler, with a 97.8% increase of prolapsectomy (p<0.001). No intra- or early postoperative complications occurred. Transrectal sonography and autopsy detected: two (50%) small intra-parietal and two (50%) extra-rectal haematomata after Standard STARR; five small intraparietal (45.5%) and one (9%) extra-rectal haematoma after CPH34 HV™ STARR mono-stapler; three (27.2%) small intraparietal and (27.2%) extra-rectal haematomata after CPH36 SMS™ STARR mono-stapler. CONCLUSION: CPH36 SMS™ STARR mono-stapler is quite feasible both from the technological and safety standpoint; most importantly, the higher volume of prolapsectomy achievable with CPH36 SMS™ compared to standard STARR with two PPH-01™ might reduce the risk of residual/recurrent prolapse and further improve the clinical efficacy of the STARR procedure.
BACKGROUND/AIM: Standard stapled transanal rectal resection (STARR) with two PPH-01™ poses some questions regarding the completeness of prolapse resection in patients with obstructed defecation syndrome (ODS) since 20% to 30% of patients have persistent rectocele or rectal intussusception that may impair the physiological recovery of rectal sensitivity. New high-volume (HV) devices, such as CPH34 HV™ and CPH36 SMS™, allow for wider prolapsectomy to be performed and we herein assessed the possibility and safety of a STARR mono-stapler. MATERIALS AND METHODS: On May 30th-31st 2011, 13 pigs were selected to undergo standard STARR with two PPH-01™ (n=2) or STARR mono-stapler with one CPH34 HV™ (n=11) at the Experimental Center of Vila do Conde (Portugal); another set of 13 pigs was selected on January 14th-17th 2014 to undergo standard STARR (n=2) or STARR mono-stapler by means of one CPH36 SMS™ (n=11). The length, height, square surface, and volume of resected specimens were intra-operatively assessed. Pigs were monitored for three days before undergoing transrectal sonography and autopsy to check for locoregional complications. RESULTS: CPH36 SMS™ STARR mono-stapler achieved 57% higher volume of prolapsectomy compared to Standard STARR (p=0.008); moreover, surface measures of the specimens of CPH36 SMS™ STARR mono-stapler were significantly higher (length, p=0.003; height, p=0.004; square surface, p=0.002) compared to CPH34 HV™ STARR mono-stapler, with a 97.8% increase of prolapsectomy (p<0.001). No intra- or early postoperative complications occurred. Transrectal sonography and autopsy detected: two (50%) small intra-parietal and two (50%) extra-rectal haematomata after Standard STARR; five small intraparietal (45.5%) and one (9%) extra-rectal haematoma after CPH34 HV™ STARR mono-stapler; three (27.2%) small intraparietal and (27.2%) extra-rectal haematomata after CPH36 SMS™ STARR mono-stapler. CONCLUSION: CPH36 SMS™ STARR mono-stapler is quite feasible both from the technological and safety standpoint; most importantly, the higher volume of prolapsectomy achievable with CPH36 SMS™ compared to standard STARR with two PPH-01™ might reduce the risk of residual/recurrent prolapse and further improve the clinical efficacy of the STARR procedure.
Authors: Giuliano Reboa; Marco Gipponi; Maurizio Gallo; Giovanni Ciotta; Marco Tarantello; Angelo Caviglia; Antonio Pagliazzo; Luigi Masoni; Giuseppe Caldarelli; Fabio Gaj; Bruno Masci; Andrea Verdi Journal: Surg Res Pract Date: 2016-02-21