Use of telemedicine in the postoperative assessment of proctological patients: a case-control study.

BACKGROUND: Telemedicine is emerging as an easy way to communicate between patients and surgeons. Use of telemedicine increased during the coronavirus disease 2019 (COVID-19) pandemic. WhatsApp is one of the most common smartphone applications for user-friendly telemedicine. The aim of this study was to evaluate patient perception of health quality and positive outcomes using a diary sent by the patient to the surgeon via WhatsApp during the first post-discharge week after proctologic surgery. METHODS: Ninety-eight patients discharged after proctologic surgery at the Israelite Hospital of Rome and the AOU Policlinico Umberto I of Rome in 1 January-31 December 2019 were divided into two groups: the WhatsApp group (group A), (n = 36) and the no WhatsApp group (group B) (n = 62). Group A patients received a protocol to follow for the day-by-day diary during the first post-discharge week and sending it by WhatsApp to the surgeon. Group B patients only received recommendations at discharge. The tool's usefulness was assessed by a questionnaire one month after the intervention. RESULTS: The two groups were homogeneous for age, sex, schooling, employment, and proctologic pathology. Group A patients had less difficulty keeping a diary (p < 0.0001). Group A patients had the perception of better follow-up post-discharge (p = 0.002). The use of the diary sent by WhatsApp significantly improved the perception of positive post-intervention outcomes (p = 0.007). WhatsApp was the only independent predictor of perception of post-surgical positive outcomes (odds ratio = 4.06; 95% CI 1.35-12.24; p = 0.01). CONCLUSIONS: The use of WhatsApp in the post-discharge period improves the lifestyle quality of the patients and their perception of the safety and quality of care received.

Posterior pelvic tilt is a risk factor for rectal prolapse: a propensity score matching analysis.

BACKGROUND: There is little evidence about possible effects of pelvic anatomical characteristics on proctological complications. The aim of our study was to investigate the potential correlation between sagittal pelvic position and rectal prolapse. METHODS: A study was conducted on a proctology patients and patients without any specific history of proctological disorders who were divided into two groups according to the presence or the absence of rectal prolapse. In all cases, the pelvic angle was measured with a pelvic goniometer and categorized as posterior (< 10°), neutral (10°-15°), and anterior (> 15°). To minimize effects of potential confounders in the analysis, 3:1 nearest neighbor propensity score matching (PSM) method was implemented using age, sex, and diagnose of rectal disorders as confounding variables. RESULTS: Among the 143 screened patients, posterior tilt was more frequent in the 19 patients with rectal prolapse than in those without prolapse (42 vs. 18%; p = 0.027). This result was also confirmed in the post-PSM analysis (42 vs. 14%; p = 0.036) using 35 propensity score (PS)-matched controls compared with the rectal prolapse group. Posterior tilt was associated with an increased risk of prolapse in both the unmatched population (odds ratio = 3.37; p = 0.020) and PS-matched subset (odds ratio = 4.36; p = 0.028). CONCLUSIONS: A posterior pelvic angle was more frequently associated with the diagnosis of rectal prolapse. In both the entire population and in the PS-matched subset, posterior tilt was a significant risk factor for rectal prolapse. The easy-to-do investigation of the pelvic angle can provide several benefits in terms of rectal prolapse prevention and more precise management of post-surgical prolapse recurrence.

Relief of hemorrhoid symptoms: pilot study of a new topical ally.

AIM: The pathogenesis of hemorrhoids involves vascular congestion, fragmentation of supporting tissues and, in many cases, increased resting anal pressure. A new ointment (Hemolen®) has been devised to control hemorrhoids symptoms acting on all the pathophysiologic mechanisms involved. METHODS: Pilot study on patients with grade I-III hemorrhoids. The ointment was applied twice daily for 30 days and follow-up visits were scheduled 7 days (T1), 14 days (T2) and 30 days (T3) after recruitment (T0). Signs and symptoms (bleeding, discomfort, itching, edema, thrombosis, congestion, inflammation, pain) were evaluated at each visit using dedicated scores and VAS scale. Resting anal pressure was measured at time T0, 1 hour after the first application and at T1. Use of painkiller was recorded. RESULTS: 48 patients (25 females; mean age 47±15.8 years) were enrolled; 52.1% of them had II degree hemorrhoids and 27.1% had III degree hemorrhoids. The severity scores significantly dropped from T0 to each scheduled visit and a significant reduction of resting anal pressure was observed from T0 to 1 hour after application (z=13.5; p<0.001) and from T0 to T1 (z=6; p<0.001). The comparison of the resting pressure among whole time series showed a significant reduction (Fr=124.4; p=<0.001). Use of pain-killers decreased significantly from T0 to T1 (p<0.001) and from T1 to T2 (p=0.001). CONCLUSION: The new ointment tested in the present study is safe and effective for the management of hemorrhoid symptoms in the early stages hemorrhoids, during the acute phases and in patients with more severe hemorrhoids awaiting surgery. Prospective, randomized controlled trials are needed to confirm these encouraging results.

The Effect of a Physical Training with the Use of an Exoskeleton on Depression Levels in Institutionalized Elderly Patients: A Pilot Study.

CONTEXT: The Human Body Posturizer (HBP) is an exoskeleton used in the neurorehabilitation. The HBP may improve motor control by stimulating the pre-frontal cortex, a brain region involved also in the inhibitory modulation of the amygdala whose hyperactivity is involved in the mechanisms of depression. OBJECTIVE: The aim of the study was to investigate in institutionalized elderly patients the effects on depression of a physical training with the use of the HBP compared to a traditional training. DESIGN: Randomized controlled trial. PARTICIPANTS: 20 institutionalized patients (mean age = 88, ds = ± 5, 3 males) with moderate depression levels. INTERVENTION: The participants were randomly assigned to: a) HBP Group, which carried out physical training using the HBP; b) Excercise Group, which carried out a training without the use of the orthosis. The training was conducted for 6 months (3 sessions each week), with the same kind of exercises with or without the HBP according to the assignment group. MEASUREMENTS: Participants were evaluated at baseline using the Tinetti balance and Gait scale, the Mini Mental State Examination and the Geriatric Handicap Scale. The Geriatric Depression Scale was administered to the participants before and after the period of training. RESULTS: The two groups were homogeneous for age, baseline motor ability (risk falls), handicap score, cognitive functioning and depression levels. After 6 months of exercise training a significant reduction in depression levels was reported only in the HBP Group (p <.01). CONCLUSIONS: A positive effect of the HBP in the modulation of mood in institutionalized elderly subjects was found. It is possible to hypothesis that a traditional training without the HBP may require more time to achieve significant results. Clinical implications will be discussed.

iProcto: new digital technology in Proctology. A randomized study.

BACKGROUND AND AIM: Advancements in technology have proved useful for many businesses including medical practices. Consequently, these improvements have increased the need to develop new applications for mobile devices. Our group conceived and developed an application for tablets, PCs, and smartphones with the aim to assist the physician in the management of the pelvic floor diseases: iProcto. The aim of this study was to evaluate the receptivity of patients resulting from using the said pelvic floor application (iProcto) during a colon-proctologic visit; and to establish whether it can be more efficient in helping with diagnosis compared to a traditional visit. METHODS: We enrolled 126 patients with pelvic floor disorders during the period of 2013 and 2014. The average age of the patients ranging from 16 - 43 years of age, 80 of those, being women. Sixty-three patients were randomly assigned to iProcto consultation (group A), the remaining 63 patients to attended a regular consultation that did not include iProcto (group B). Post consultation, all patients were asked to answer a questionnaire anonymously where they were asked questions about their level of satisfaction, and clarity of the doctor's explanation, on a scale from 1 (dissatisfied) to 5 (completely satisfied). RESULTS: Patients in group A have a score average relative to the degree of satisfaction of 4.2 ± 0.7 vs 3.5 ± 0.7 in the group B (m ± sd; p 0.001). Only 3 patients in group A and 15 in group B did not consider the visit satisfactory (score ≤2). With regard to the clarity of the physician the group A patients presented a means score of 4.4 ± 0.8 vs 3.5 ± 0.4 in the group B (m ± ds; p 0.001). Data shows that 95% showed a gain in satisfaction during the iProcto visit as compared to 78% without iProcto. CONCLUSIONS: In conclusion the use of iProcto for the pelvic floor diseases can improve the understanding of the disease and increase the degree of patient satisfaction.

Manual reduction in acute haemorrhoids.

AIM: In prolapsed internal hemorrhoids exposed outside the anus, manually reducing the prolapse with 48 hours of commencement of anal pain, decreased the progression of thrombosis. The aim of our study was to evaluate the effects of manual reduction of the inflamed piles hemorrhoids. MATERIALS OF STUDY: Eleven patients, 7 males and 4 pregnant females (in early post partum) with an average age of 34 years ± 8 (range 23- 52) were enrolled with anal pain cause by haemorrhoidal congestion, but prior to full blown thrombosis. Patients underwent a manual reduction of the external prolapsed haemorrhoidal plexus. In the 48 hours following the procedure, patients were instructed on how to insert any prolapsed hemorrhoid (piles) themselves. Pain intensity was measured using the visual analog scale (VAS) at time of consultation and then 10 days after the reduction. RESULTS: At day 10 following treatment we observed a statistically significant reduction in anal swelling (11 vs 1, n° pzt; p = 0.001), anal pain (11 vs 2, n° pzt; p = 0.001) and VAS score (8.6 ± 0.7 vs 0.4 ± 1.2; p = 0.001). Two patients (18%) underwent surgical haemorrhoidectomy sec. Milligan Morgan and 1 patient (9%) underwent excision of thrombosed external hemorrhoids. 73% of patients did not require surgery. CONCLUSIONS: Manual reduction of the prolapsed piles outside the anus decreased pain immediately and it also allows postponement of surgery or any other treatment.

[Local and late complications in anorectal surgery]. / Complicanze locali tardive nella chirurgia anorettale.

BACKGROUND AND AIMS: Our experience in colon-proctology showed the need to update the post-surgical complications score we published (1), adding others that may have an impact on outcome of treatment. The aim of this study was to assess the efficacy of a score obtained from the analysis of the quality of life and severity of complications after proctologic surgery. MATERIALS AND METHODS: Between January and December 2013, we studied 150 patients undergoing several ano-rectal surgeries for the presence of hemorrhoids of grade III and IV (63 patients), anal fissures (42 patients), anal fistulas (19 patients), rectocele (15 patients) and mucosal prolapse of the rectum (11 patients). After surgery, patients were evaluated through outpatient visits at 3, 6 and 12 months, by a questionnaire concerning the surgery complications and quality of life, the latter expressed with a score from 0 (poor) to 10 (excellent). RESULTS: Only 134 patients [mean age: 49 years (range 35-61 years), 62 M] completed the entire follow-up. The score of complications has been gradually decreasing from 11.3 (baseline) to 9.6 to 3 months, 3.6 to 6 months and 2.3 at 12 months, while the score of the quality of life progressively increased from 4.5 to 6, 8 and 8.5 respectively (p<0.05), with a correlation between the two score (r=-0.6, p= 0.03). CONCLUSIONS: The quantification by scores of quality of life and postoperative complications in colon-proctology is an important prognostic predictor.

[Rubber band ligation in treatment of hemorrhoids: our experience]. / Legatura elastica delle emorroidi: nostra esperienza.

OBJECTIVES: Hemorrhoids are a very common condition. The treatment depends upon persistence and severity of symptoms. For hemorrhoids of II and III grade the rubber band ligation may be therapeutic. Our aim is to report the outcomes of rubber band ligation of hemorrhoids, with a follow up of 6 months. MATERIALS AND METHODS: A total of 50 patients underwent rubber band ligation for symptomatic hemorrhoids (grade II and III) without prolapse, between June 2012 and June 2014. All patients underwent plug test to rule out presence of rectal mucosal prolapse and were classified according to PATE classification (1). Each hemorrhoid was ligated with one rubber band through a ligator. All patients were evaluated immediately at the end of the procedure, after ten days and six months after the treatment. Patient's demographic and operative data were collected and analyzed. RESULTS: The mean patients age was 47.6±12.3 years (range 24-72). All procedures were performed without complications. Before rubber band ligation, 42 patients had rectal bleeding, 38 had perineal discomfort and 27 had itching. Ten days after the treatment, 12 patients presented self-limited rectal bleeding, but 10 of these had more hemorrhoids and underwent a second rubber band ligation. No patients complained perineal discomfort, and 8 patients had itching; 78% and 16% of patients respectively, experienced feeling of a foreign body inside the canal anal and anal pain. After 6 months, only 13 patients were occasionally symptomatic: 4 patients had rectal bleeding, 2 had perineal discomfort and 4 had itching. Three more patients presented both perineal discomfort and hitching. None had the feeling of a foreign body in anal canal or anal pain. CONCLUSIONS: Rubber band ligation is an efficacious, cost-effective and simple treatment for the second and third degree hemorrhoids without rectal mucosal prolapsed. In our hands, no severe complications developed and minor complications could be handled with ease.

Hemoperitoneum: a rare complication of hemorrhoid treatment.

Pile suturing has always been used by surgeons to treat hemorrhoidal disease. We report a case of hemoperitoneum complicating a pile suture. Ultrasonography and computed tomography scan indicated the need for an emergency laparoscopic procedure and conservative management. As other authors have pointed out, we do not know how to prevent this type of complication. This case suggests the possibility of life-threatening complications following treatment procedures for hemorrhoids and underlines the importance of conservative treatment when this is possible.

[Efficacy and safety of a salsobromoiodic gel solution in proctological surgery]. / Efficacia e sicurezza di una soluzione salsobromoiodica in chirurgia proctologica.

BACKGROUND: Surgical procedures for ano-rectal pathologies are always conditioned by an high percentage of side-effects. Indeed, the prevention of probable complications such as the non tissue-recovery or infection is a fundamental topic to guarantee an adequate follow-up. The aim of this comparative study is to assess the short-term outcomes of the use of a solution salsobromoiodic gel solution in postoperative period of patients undergoing proctological surgery. MATERIALS AND METHODS: The authors selected retrospectively a population of 80 patients, undergoing surgery for Milligan-Morgan hemorrhoidectomy. Based on the recommended medications postoperatively, patients were divided into two groups: the Group A applied the salsobromoiodic solution gel on the perianal surgical wound in the postoperative period, the Group B did not use any medical facility with the exception of a soap at neutral pH. The clinical features assessed at 5, 10, 15 and 30 days after surgery were: pain, burning and itching lenght, the healing time, the presence or absence of early or late superinfection, the time of re-epithelization, the need for surgical curettage. The subjective evaluation of quality of life was assessed using a Visual Analogue Scale (VAS). RESULTS: There was a statistically significant reduction in length of postoperative pain in patients of Group A compared to Group B (5.6 vs 10.4 days respectively; p<0.005). There was a more rapid wound healing and re-epithelialization in group A, 15 and 21,3 days, respectively, as compared to Group B, 22.9 and 31.7 days (p<0.005). There were no differences between the two groups in terms of burning, itching and early and late bacterial infection. Two patients in Group B required a surgical debridement of the wound. Patients who used postoperatively salsobromoiodic solution declared a better quality of life. CONCLUSIONS: The use of salsobromoiodic gel solution in the postoperative proctological surgery, resulted safe and was effective in reducing postoperative pain, in contributing wounds healing and improving the quality of life, as subjectively assessed by each patient.

[Ideation of a new operative anoscope in proctology]. / Ideazione di un nuovo anoscopio operativo in proctologia.

BACKGROUND: Rectocele is defined as an erniation of the anterior rectal and vaginal wall in the vaginal lumen due to the loss of recto-vaginal septum. Rectal mucosal prolapse was characterized by the protrusion of the mucosa alone in the rectal lumen. The Authors, herein, reported the results of a new surgical technique defined Sequential Transfixed Stitch Technique (STST) using a new anoscope. MATERIALS AND METHODS; A total of 30 consecutive patients symptomatic III or IV stage rectocele assessed with clinical and instrumental criteria were submitted to STST using the new anoscope. The new anoscope, consisting of non-toxic metallic material, designed and realized according to surgery needs and tested by the authors, increases the vision of the anal canal can be fixed according to the operator's needs. RESULTS: STST was correctly performed in all the cases without early and late complications. The mean value was of 17 according to the Agachan-Wexner for patients with rectocele, significantly improved score in comparison to pre-operatory condition (p<0.05). Surgical procedure of rectocele repair was judged satisfactory in 80% of the cases. CONCLUSIONS: The new operative anoscope was useful in III and IV stage rectocele repair with STST, ensuring ease of implementation of the binding repair in the absence of side effects for the patient.

[Mucoprolassectomy with circular stapler: early results with a new device]. / Mucoprolassectomia con suturatrice circolare: utilizzo di un nuovo device.

AIMS: Stapled transanal mucosectomy is widely used by a lot of surgeon and in RCT, when compared to other haemorrhoidectomy techniques, it didn't show a real primacy. We describe results obtained with a new device, the EEA™ 33-mm Hemorrhoid and Prolapse Stapler Set con DST Series™ (Covidien™), used on 65 patients. PATIENTS AND METHODS: Sixty-five patients underwent a stapled transanal mucosectomy for grade III (n° 20), IV (n° 15) haemorrhois and rectal prolapse (n° 30). The operation were performed by two surgeons. Results. Resected tissue had a mean width of 4.2 cm (3.3-6.1 cm) and a mean weight of 11 g (8-21 g). Surgical time were 22 min (15-35 min). Bleeding of the suture line were observed in 5 cases (7.7%) and they required a mean of 2 haemostatic stitch (1-5) in adsorbable suture 2/0. Mucoprolapsectomy was considered excellent in 55 patients (84.7%), good in 8 patients (12.3%), bad in 2 patients (3%) by surgeons. There were no early and late complications like bleeding, abscesses, anastomotic dehiscence. We report two case of perianal haematoma that don't need any treatment and one case of anal stenosis treated with dilatation therapy. Post-operative pain, estimated with VAS, emphasized an excellent response to NSAIDs in first postoperative day, in 10 cases (15.4%) we prolonged analgesic therapy for 3 days, in one case (1.5%) for one week. After 6 month all patients were revaluated with physical examination and anoscopy. Only one patient (1.5%) had an asymptomatic recurrence of rectal prolapse. CONCLUSION: We conclude that the new device makes easy and standardized surgery. The new device reduce a lot of difficult in patients with tight pelvis and a small distance between ischiatic tubers.

[Identification of internal fistolous orifice: evolution of methylene blue technique with a mini-probe]. / Identificazione dell'orifizio fistoloso interno: evoluzione della tecnica di iniezione con blu di metilene tramite mini-catetere.

INTRODUCTION: Often perianal fistulas can be difficult typing and traditional anatomical classifications do not help the surgeon in accurate diagnosis of the fistula as an outpatient procedure and therefore does not allow a timely surgical currettage. The aim of our study was to introduce in the management of anal fistulas performed on an outpatient injection with methylene blue of the fistula through a small polyethylene catheter in order to detect in real time the internal opening of the fistula and drive so the next currettage surgery. MATERIALS AND METHODS: A total of 50 consecutive patients 21 female and 29 male, relating to our clinic with symptoms suggestive of colon proctology perianal fistula, aged between 36 and 69 years were selected for our study. After running the news-gathering medical history, physical examination, digital examination through examination anoscope, using a polyethylene catheter in a small scale, of methylene blue was injected through the external fistula orifice looking inside the spreading of liquid. Subsequently, the patient was started on specillazione currettage and possible surgery. RESULTS: 62 outpatients were treated intramural fistulas, diagnosed with the injection technique with methylene blue running always probing and practiced a wide dish made of the mucosa, submucosa and circular muscle layer of the internal drainage with sphincterotomy. In particular, the technique injection of methylene blue was sufficient to diagnose 42 out of 62 cases examined (67.7%). In the remaining 20 cases it was necessary to integrate diagnosis with MRI-defecates on the complexity of fistulas (10 horseshoe, 6 trans sphincteric and 4 intersphincteric. CONCLUSIONS: Methylene blue injection is a low-cost screening technique, simple to perform on an outpatient basis and in the case of suprasphincteric fistulas also a simple diagnostic technique is sufficient to allow the closure of the fistula.

[Results about the use of a silicone catheter in the stadiation of rectal mucosal prolapse and hemorrhoidal prolapse]. / Risultati sull'uso di un catetere siliconato nella stadiazione del prolasso mucoso del retto o del prolasso emorroidario.

INTRODUCTION: Rectal mucosal prolapse was characterized by the protrusion of the mucosa alone in the rectal lumen. Hemorrhoidal prolapse is an extreme pathological condition oh haemorrhoidal disease. The Authors after an experience conducted in ambulatory patients have performed a technique for the staging of rectal mucosal prolapse and hemorrhoidal prolapse based on the use of an endorectal silicone catheter with a balloon in the extremity. PATIENTS AND METHODS: A total of 40 patients with proctological symptoms during ambulatory visit has been submitted to a less invasive test in comparison to those traditional, using an endorectal silicone catheter with a balloon in the extremity, to insert in rectal lumen and to remove outside through the anus. RESULTS: Only in 18 patients, the method gave the exact size of the prolapse and only 16 patients was able to accurately predict the reducibility or not. Of the 18 patients in 12 patients showed a mucosal prolapse was 50% of the circumference of the anal canal, in 6 patients showed a prolapse was between 50% and 75%. In 22 patients had been diagnosed with the absence of prolapse, then denied by the plug test that showed prolapse below the 50%. CONCLUSIONS: The assessment of mucosal prolapse and hemorrhoidal prolapse through silicone catheter test has not proven better than the traditional plug test.

[Utility of plug test during anoscopy for the ambulatory evaluation of rectal mucosal prolapse]. / Utilità del test della garza durante anoscopia per la stadiazione ambulatoriale del prolasso mucoso del retto.

INTRODUCTION: Rectal mucosal prolapse was characterized by the protrusion of the mucosa alone in the anal lumen. The Authors, to correctly establish the intraoperatory stage of rectal mucosal prolapse have performed a test based on the intrarectal introduction of a plug of great dimension, to successively pull-through the anal canal during anoscopy. PATIENTS AND METHODS: A total of 30 patients with proctological symptoms and with diagnosis of rectal mucosal prolapse has been submitted, in ambulatory setting, to a less invasive test with a small plug and in second time, using a plug entirely inserted in rectal lumen and to remove outside through the anus during anoscopy. RESULTS: In all cases the plug test used during anoscopy permitted the perfect evaluation of the prolapse extension. In 12 patients the plug test evidenced a mucosal prolapse occupying the 25% of anal canal, in 10 patients the 50% of anal canal and in 8 patients a mucosal prolapse occupying up to the 50% of the anal circumference. The first 22 patients were treated transfixed stitch technique (TST) while for the other patients Longo surgical technique was preferred. CONCLUSIONS: The plug test during anoscopy is efficacious to achieve differential diagnosis between rectal mucosal prolapse and haemorrhoidal prolapse. Indeed. it is useful to choice more precisely the type of surgical intervention.

[Chronic pelvic pain treatment with posterior tibial nerve stimulation]. / Trattamento del dolore pelvico cronico mediante stimolazione del nervo tibiale.

INTRODUCTION: Chronic pelvic pain is a common problem that has a high impact on quality of life of patients who are affected. The technique of percutaneous neuromodulation by electrical stimulation of the tibial nerve (Percutaneous Tibial Nerve Stimulation PTNS) is described by Stoller for the treatment of overactive bladder syndrome in the 90s is currently being tested in the treatment of chronic pelvic pain. MATERIALS AND METHODS: The study included 35 patients with chronic pelvic pain: 17 were treated with a protocol based on 12 PTNS stimulation sessions performed weekly (Group A), 18 were treated with a protocol based on 12 sessions PTNS stimulation performed 3 times a week (group B). All patients were evaluated before and after treatment, by means of diary quality of life score (I-QoL, SF36) and proctologic examination. RESULTS: At the end of treatment 11/17 patients (63%) in group A and 12/18 patients (67%) in group B were considered a successes. Overall 4/11 (36%) patients in group A and 5/11 (45%) patients in group B recovered completely after treatment. In both groups, patients reported a subjective improvement after 6-8 stimulation sessions. At follow-up 36/8 months there were more complications. CONCLUSIONS: In conclusion, the use of PTNS in the treatment of chronic pelvic pain shows encouraging results in patients not responding to standard analgesic therapy.

[Treatment of rectocele and rectal mucosal prolapse with mucosal flaps excision and with manual reconstruction]. / Trattamento del rettocele e del prolasso mucoso del retto con escissione a lembi della mucosa con sutura manuale (Tecnica di "Delorme interna" modificata).

BACKGROUND: Rectocele is defined as an erniation of the anterior rectal and vaginal wall in the vaginal lumen due to the loss of rectovaginal septum. Rectal mucosal prolapse was characterized by the protrusion of the mucosa alone in the rectal lumen. The Authors, herein, reported the results of a new surgical technique with the excision of one or more mucosal or muco-muscolar flaps and reconstruction with Sequential Transfixed Stitch Technique (STST) using a anal retractor designed by them. MATERIALS AND METHODS: The new surgical technique was applied to 40 consecutive patients with rectal mucosal prolapse and 20 with symptomatic rectocele of III degree assessed with 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. The quality of life was defined using a questionnaire before surgery, at 3 and 6 months of follow-up. Data were evaluated according to the Agachan-Wexner score. RESULTS: The new technique was correctly performed in all the cases without early and late complications. The mean value was of 18.2 according to the Agachan-Wexner for patients with rectocele and 17.6 for rectal mucosal prolapse, both significantly improved score in comparison to pre-operatory condition (p<0.05). Surgical procedure with flaps excision and manual procedure of STST was judged satisfactory in 89% of the cases. CONCLUSIONS: The treatment of symptomatic rectocele and rectal mucosal prolapse with multiple excision of exceeding tissue flaps and the reconstruction with STST manually conducted showed optimal results for the surgical treatment of in our experience with a significant improvement of quality of life referred by the patients and absence of significant post-operative side effects.