Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception

Abstract

Aim: To evaluate the safety and efficacy of stapled transanal rectal resection (STARR), and to analyze the outcome of the patients 12-mo after the operation.

Methods: From May 2007 to October 2008, 50 female patients with rectocele and/or rectal intussusception underwent STARR. The preoperative status, perioperative and postoperative complications at baseline, 3, 6 and 12-mo were assessed. Data were collected prospectively from standardized questionnaires for the assessment of constipation [constipation scoring system, Longo's obstructed defecation syndrome (ODS) score system, symptom severity score], patient satisfaction (visual analogue scale), and quality of life (Patient Assessment of Constipation-Quality of Life Questionnaire).

Results: At a 12-mo follow-up, significant improvement in the constipation scoring system, ODS score system, symptom severity score, visual analog scale and quality of life (P < 0.0001) was observed. The symptoms of constipation improved in 90% of patients at 12 mo after surgery. The self-reported definitive outcome was excellent in 15 (30%) patients, fairly good in 8 (16%), good in 22 (44%), and poor in 5 (10%).

Conclusion: STARR can be performed safely without major morbidity. Moreover, the procedure seems to be effective for patients with obstructed defecation associated with symptomatic rectocele and rectal intussusception.

Figure 1

Comparison of scores at baseline and at a 12-mo follow-up. A: Comparison of constipation scoring system (CSS) scores; B: Comparison of Longo’s obstructed defecation syndrome (ODS) scores; C: Comparison of symptom severity (SS) scores; D: Comparison of visual analog scale (VAS) scores. A significant reduction in the CSS, ODS, SS and VAS scores was observed at 12 mo after surgery as compared with baseline (paired t test , ^bP < 0.0001).