European Surgery

, Volume 45, Issue 1, pp 21–25

Clinical outcome after stapled transanal rectal resection for obstructed defecation syndrome: the first Iranian experience

  • R. Azizi
  • M. Alvandipour
  • A. Bijari
  • S. Shoar
  • M. Alemrajabi
Original Scientific Paper

Summary

Background

Despite advances in treatment of obstructed defecation syndrome (ODS), no single therapy has been tolerated by all patients. Recently, stapled transanal rectal resection (STARR) has been shown to be a time-saving and relatively easy procedure for treatment of ODS with increasing acceptance by both the patient and surgeon. Our study indeed aimed to evaluate the efficacy and safety of STARR in patients with ODS due to anatomic abnormalities.

Methods

Fifty consecutive patients with ODS due to symptomatic rectal intussusceptions or rectocele were enrolled in this study. Preoperatively, all patients underwent rectosigmoidoscopy and defecography. All the patients with ODS score ³ 9 and rectal intussusceptions and/or rectocele with failure of at least 6 months medical treatment underwent STARR. Wexner incontinence score, ODS score, and Wexner score for severity of constipation were measured for each patient before and after the surgery.

Results

Mean ± standard deviation (SD) age of patients was 48.1 ± 1.1 years. Mean ± SD Longo score was 14.7 ± 0.9 before the procedure and 4.3 ± 0.7 after the procedure, which revealed statistically significant difference (p < 0.0001). The mean ± SD Wexner incontinence score was 0.6 ± 0.2 and 1.2 ± 0.3 before and after the STARR, respectively, which did not differ significantly (p = 0.1). However, Wexner constipation score revealed significant improvement after the surgery (13.9 ± 0.6 before the surgery vs. 3.4 ± 0.5 after the surgery; p < 0.0001).

Conclusions

STARR in patients with ODS due to rectocele or intussusceptions is associated with higher patient’s satisfaction and improvement in constipation, incontinency, and defecation score. STARR may be considered an alternative therapeutic option in ODSs with no desired response to other treatments.

Keywords

Obstructed defecation syndrome Stapled transanal rectal resection ODS score Wexner score STARR 

References

  1. 1.
    Ding JH, Zhang B, Bi LX, Yin SH, Zhao K. Functional and morphologic outcome after stapled transanal rectal resection for obstructed defecation syndrome. Dis Colon Rectum. 2011;54(4):418–24.PubMedCrossRefGoogle Scholar
  2. 2.
    Longo A. Treatment of hemorrhoid disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. Presented at the meeting of the World Congress of Endoscopic Surgery; June 3 to 6; Rome, Italy1998.Google Scholar
  3. 3.
    Ng K, Ho K, Ooi B, Tang C, Eu K. Experience of 3711 stapled haemorrhoidectomy operations. Br J Surg. 2006;93:226–30.PubMedCrossRefGoogle Scholar
  4. 4.
    Andromanakos N, Skandalakis P, Troupis T, Filippou D. Constipation of anorectal outlet obstruction: pathophysiology, evaluation and management. J Gastroenterol Hepatol. 2006;21(4):638–46.PubMedCrossRefGoogle Scholar
  5. 5.
    Jayaraman S, Colquhoun PH, Malthaner RA. Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery. Dis Colon Rectum. 2007;50(9):1297–305.PubMedCrossRefGoogle Scholar
  6. 6.
    Jayne DG, Schwandner O, Stuto A. Stapled transanal rectal resection for obstructed defecation syndrome: one-year results of the European STARR Registry. Dis Colon Rectum. 2009;52(7):1205–12; discussion 12–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Zehler O, Vashist YK, Bogoevski D, Bockhorn M, Yekebas EF, Izbicki JR, et al. Quo vadis STARR? A prospective long-term follow-up of stapled transanal rectal resection for obstructed defecation syndrome. J Gastrointest Surg. 2010;14(9):1349–54.PubMedCrossRefGoogle Scholar
  8. 8.
    Felt-Bersma RJ, Tiersma ES, Cuesta MA. Rectal prolapse, rectal intussusception, rectocele, solitary rectal ulcer syndrome, and enterocele. Gastroenterol Clin North Am. 2008;37(3):645–68, ix.PubMedCrossRefGoogle Scholar
  9. 9.
    Schwandner O, Stuto A, Jayne D, Lenisa L, Pigot F, Tuech JJ, et al. Decision-making algorithm for the STARR procedure in obstructed defecation syndrome: position statement of the group of STARR Pioneers. Surg Innov. 2008;15(2):105–9.PubMedCrossRefGoogle Scholar
  10. 10.
    van Dam JH, Ginai AZ, Gosselink MJ, Huisman WM, Bonjer HJ, Hop WC, et al. Role of defecography in predicting clinical outcome of rectocele repair. Dis Colon Rectum. 1997;40(2):201–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Boccasanta P, Venturi M, Stuto A, Bottini C, Caviglia A, Carriero A, et al. Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial. Dis Colon Rectum. 2004;47(8):1285–96; discussion 96–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Frascio M, Stabilini C, Ricci B, Marino P, Fornaro R, De Salvo L, et al. Stapled transanal rectal resection for outlet obstruction syndrome: results and follow-up. World J Surg. 2008;32(6):1110–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Pechlivanides G, Tsiaoussis J, Athanasakis E, Zervakis N, Gouvas N, Zacharioudakis G, et al. Stapled transanal rectal resection (STARR) to reverse the anatomic disorders of pelvic floor dyssynergia. World J Surg. 2007;31(6):1329–35.PubMedCrossRefGoogle Scholar
  14. 14.
    Arroyo A, Perez-Vicente F, Serrano P, Sanchez A, Miranda E, Navarro JM, et al. Evaluation of the stapled transanal rectal resection technique with two staplers in the treatment of obstructive defecation syndrome. J Am Coll Surg. 2007;204(1):56–63.PubMedCrossRefGoogle Scholar
  15. 15.
    Arroyo A, Gonzalez-Argente FX, Garcia-Domingo M, Espin-Basany E, De-la-Portilla F, Perez-Vicente F, et al. Prospective multicentre clinical trial of stapled transanal rectal resection for obstructive defaecation syndrome. Br J Surg. 2008;95(12):1521–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Titu LV, Riyad K, Carter H, Dixon AR. Stapled transanal rectal resection for obstructed defecation: a cautionary tale. Dis Colon Rectum. 2009;52(10):1716–22.PubMedCrossRefGoogle Scholar
  17. 17.
    Hasan HM. Stapled transanal rectal resection for the surgical treatment of obstructed defecation syndrome associated with rectocele and rectal intussusception. ISRN Surg. 2012;2012:652345.PubMedGoogle Scholar
  18. 18.
    Zhang B, Ding JH, Yin SH, Zhang M, Zhao K. Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception. World J Gastroenterol. 2010;16(20):2542–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD. A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum. 1996;39(6):681–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Boenicke L, Jayne DG, Kim M, Reibetanz J, Bolte R, Kenn W, et al. What happens in stapled transanal rectum resection? Dis Colon Rectum. 2011;54(5):593–600.PubMedCrossRefGoogle Scholar
  21. 21.
    Schwandner T, Hecker A, Hirschburger M, Hecker M, Kierer W, Padberg W. Does the STARR procedure change the pelvic floor: a preoperative and postoperative study with dynamic pelvic floor MRI. Dis Colon Rectum. 2011;54(4):412–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Ommer A, Albrecht K, Wenger F, Walz MK. Stapled transanal rectal resection (STARR): a new option in the treatment of obstructive defecation syndrome. Langenbecks Arch Surg. 2006;391(1):32–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Pescatori M, Zbar AP. Reinterventions after complicated or failed STARR procedure. Int J Colorectal Dis. 2009;24(1):87–95.PubMedCrossRefGoogle Scholar
  24. 24.
    Wolff K, Marti L, Beutner U, Steffen T, Lange J, Hetzer FH. Functional outcome and quality of life after stapled transanal rectal resection for obstructed defecation syndrome. Dis Colon Rectum. 2010 Jun;53(6):881–8.Google Scholar
  25. 25.
    Mellgren A, Bremmer S, Johansson C, Dolk A, Uden R, Ahlback SO, et al. Defecography. Results of investigations in 2,816 patients. Dis Colon Rectum. 1994;37(11):1133–41.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • R. Azizi
    • 1
  • M. Alvandipour
    • 1
  • A. Bijari
    • 1
  • S. Shoar
    • 1
    • 2
  • M. Alemrajabi
    • 1
  1. 1.Department of Colorectal SurgeryRasoul-e-Akram Hospital, Tehran University of Medical SciencesTehranIran
  2. 2.Department of SurgeryShariati Hospital, Tehran University of Medical SciencesTehranIran

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