Stapled trans-anal rectal resection can improve constipation symptoms and inflammatory reaction of patients with outlet obstructive constipation

Abstract

Objective: To explore the effect of stapled trans-anal rectal resection (STARR) on constipation symptoms and inflammatory reaction in patients with outlet obstructive constipation (OOC).

Methods: From January 2019 to June 2020, a retrospective analysis was conducted on the medical data of 124 patients with OOC admitted to our hospital. According to the different surgical methods, sixty patients were assigned to the control group (CG) treated with Bresler operation, and sixty-four patients were included in the research group (RG) receiving STARR. The total effective rate of treatment, the incidence of postoperative complications, and mid- and long-term recurrence rate were observed between the two groups. The anorectal dynamic indexes, the constipation scoring system (CSS), obstructive defecation syndrome (ODS), visual analogue scale (VAS) scores, and the changes of inflammatory cytokine [tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6)] were compared between the two groups, and the perioperative indexes were observed.

Results: After operation, a remarkably higher total effective rate was observed in the RG as compared to the CG. The RG obtained lower results in terms of the incidence of postoperative complications, 3-year recurrence rate, operation cost, and intraoperative blood loss than CG. Compared with patients in the CG, those in the RG had shorter operation time, first exhaust time, time of leaving bed, and hospitalization time. Moreover, a shorter defecation time of patients in the RG was also obtained 14 days after treatment. In addition to rectal rest pressure that was similar between the two groups, the anal maximal contraction pressure, anal longest contraction time, anorectal relaxation pressure, and anal rest pressure were significantly higher in the RG than in the CG. After operation, remarkably lower CSS and ODS scores of patients were obtained in the RG than in the CG. The RG yielded lower VAS scores after operation and 24 hours after operation, and lower levels of TNF-α and IL-6 1 day after operation in contrast to the CG.

Conclusion: STARR can effectively improve the clinical efficacy, ameliorate the symptoms of postoperative constipation, reduce the long-term recurrence rate, relieve postoperative pain, and better protect the anorectal function and mitigate inflammatory reaction for patients with obstructive constipation.

Keywords: Stapled trans-anal rectal resection; constipation symptoms; inflammatory reaction; outlet obstructive constipation.

Figure 1

Comparison of anorectal dynamic indexes. Before therapy, there was no striking difference in defecation time (A), AMCP (B), ARRP (C), ARP (D), RRP (E), and ALCT (F) between the two groups. 14 days after therapy, the defecation time (A) of patients in RG was significantly shorter than that in CG, and the AMCP (B), ALCT (F), ARRP (C), and ARP (D) were significantly higher than those in CG, while there was no striking difference in RRP (E) between the two groups. Note: ***P<0.001.

Figure 2

Comparison of CSS score. There was no striking difference in CSS scores between the two groups before operation, and the CSS scores of the patients in RG were significantly lower than those in CG one month after operation and six months after operation. Note: ***P<0.001; a means the comparison with the CG at 1 month after surgery, P<0.001; b represents the comparison with the CG at 6 months after surgery, P<0.001.

Figure 3

Comparison of ODS scores. There was no striking difference in ODS scores between the two groups before operation, and there was no striking difference in ODS scores between the two groups 1 month after operation, but the ODS scores in RG were significantly lower than those in CG 6 months after operation. Note: ***P<0.001. A represents the comparison with the CG 6 months after surgery, P<0.001.

Figure 4

Comparison of VAS score. The VAS scores of patients in RG were significantly lower than those in CG at the end of operation and 24 hours after operation Note: ***P<0.001.

Figure 5

Comparison of inflammatory factors. On the first day after operation, the levels of serum TNF-α (A) and IL-6 (B) in the two groups were significantly higher than those before operation, and the RG was significantly lower than that in CG. Note: ***P<0.001.