, Volume 20, Issue 1, pp 83-85
Date: 02 Sep 2004

Rectovaginal fistula after double-stapled transanal rectotomy (STARR) for obstructed defaecation

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Dear Editor:

We read with interest the paper by Boccasanta et al. [1] reporting a prospective study comparing transanal rectal mucosal prolapsectomy with levatorplasty and double-stapled rectal resection (the STARR procedure) in a consecutive series of patients with obstructed defaecation. The latter operation has somewhat quickly gained popularity amongst the colorectal fraternity and the public without much in the way of objective clinical data and we would recommend that its use be very selective and as here, part of a clinical trial [2]. In this paper by Boccasanta and colleagues, there was a high operative rate for symptomatic constipation (nearly half the cases referred) and given the high incidence of multiple disorders in these patients, such as an enterocele, nonrelaxing puborectalis syndrome, associated urinary difficulty and sexual dysfunction [3, 4], this would mitigate against unselected use of these operations in cases in which much of this attendant symptomatology will be