Effect of Adding Transverse Perineal Support to Stapled Transanal Rectal Resection for Anterior Rectocele With Excessive Perineal Descent: A Randomized Controlled Trial
Effect of Adding Transverse Perineal Support to Stapled Transanal Rectal Resection for Anterior Rectocele With Excessive Perineal Descent: A Randomized Controlled Trial
This prospective randomized controlled trial will include adult patients with ODS, anterior rectocele ≥3 cm, and excessive perineal descent following failure of conservative treatment.
Patients will be randomized 1:1 to STARR alone or STARR combined with transverse perineal support procedure using polypropylene mesh. The primary outcome will be Change in Altomare Obstructed Defecation Syndrome (ODS) score in both groups. Secondary outcomes will include operative time, postoperative pain, surgical complications, surgical site infection, and sexual function assessed using the PISQ-12. Patients will be followed up twice during the first postoperative week, weekly during the first month, and monthly thereafter.
Inclusion Criteria:
Exclusion Criteria:
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This will be a prospective, randomized controlled trial conducted at Kasr Al-Ainy Hospitals, Cairo University, including adult patients of either sex with obstructed defecation syndrome (ODS) associated with rectocele, and excessive perineal descent. Eligible patients must have anterior rectocele ≥3 cm, excessive perineal descent, and failure of conservative treatment. Patients with Slow-transit constipation, anterior rectocele of < 3 cm, complete external rectal prolapse, evidence of colorectal carcinoma or Inflammatory bowel disease ( IBD), Patients with fecal incontinence, Inability for lifestyle change postoperatively, or previous surgeries for anterior rectocele will be excluded.
Following informed written consent, Eligible participants will be randomized in a 1:1 ratio using computer-generated randomization, with allocation concealment through sequentially numbered, opaque, sealed envelopes.
Patients will be allocated to either Group A (STARR alone) or Group B (STARR combined with transverse perineal support using non-absorbable polypropylene mesh). Postoperative assessment will include operative time, pain using the visual analogue scale, and postoperative complications.
Patients will be followed-up twice weekly in the first postoperative week, weekly during the first month, and monthly thereafter. The primary outcome will be Change in Altomare Obstructed Defecation Syndrome (ODS) score in both groups. Secondary outcomes will include operative time, postoperative pain, surgical site infection, sexual function assessed by Pelvic Organ Prolapse/Urinary incontinence sexual questionnaire (PISQ-12), and postoperative complications.