Abstract
Purpose
Functional results following surgery for obstructed defecation (OD) have been widely investigated, but there are few reports aimed to analyze postoperative complications and re-interventions. This study investigates the adverse events requiring retreatment for obstructed defecation.
Methods
We retrospectively analyzed the records of 203 patients operated on by a single surgeon, 20 transabdominally and 183 transperineally (159 manual and 24 stapled). Postoperative complications requiring retreatment and outcome of reinterventions were analyzed.
Results
Adverse events requiring retreatment occurred in 14.3% more frequently after abdominal than after perineal procedures (20% vs. 13.7%), but the sample size of the two arms is different. Rectal bleeding and strictures were the most common adverse events (6.9%). Major complications, i.e., ischemic colitis requiring hemicolectomy and pelvic sepsis requiring colostomy also occurred (1%). The overall reintervention rate was 7.5%, (5% after abdominal and 7.6% after perineal surgery). Overall, 59% of the reoperated patients were still constipated at a median follow up of 2 years.
Conclusions
Complications requiring retreatment are not uncommon after surgery for OD and reinterventions are often unsuccessful. A careful preoperative evaluation and selection of patients should be undertaken in order to minimize adverse events.
Similar content being viewed by others
References
Pescatori M, Spyrou M, Pulvirenti D’Urso A (2006) A prospective evaluation of occult disorders in obstructed defecation using the “Iceberg diagram”. Colorectal Dis 8:785–789
Brown AJ, Anderson JH, Mckee RF, Finlay IG (2004) Surgery of occult rectal prolapse. Colorectal Dis 6:175–179
Pescatori M, Boffi F, Russo A, Zbar AP (2006) Complications and recurrence after excision of rectal internal mucosal prolapse for obstructed defaecation. Int J Colorectal Dis 21:160–165
Pechlivanides G, Tsiaoussis J, Athanasakis E, Zervakis N, Gouvas N, Zacharioudakis G, Xynos E (2007) Stapled transanal rectal resection (STARR) to reverse the anatomic disorders of pelvic floor dyssinergia. World J Surg 31:1329–1335
Gagliardi G, Pescatori M, Altomare DF, Binda GA, Bottini C, Dodi G, Filingeri V, Milito G, Rinaldi M, Romano G, Spazzafumo L, Trompetto M, Italian Society of Colo-Rectal Surgery (SICCR) (2008) Results, outcome predictors, and complications after stapled transanal rectal resection for obstructed defecation. Dis Colon Rectum 51:186–195
Bruni T, Occelli G (2006) The Italian Society of Colo-Rectal Surgery (SICCR) Annual Report of the Coloproctology Units (UCP Club). Tech Coloproctol 10:274–275
Hwang YH, Person B, Choi JS et al (2006) Biofeedback therapy for rectal intussusception. Tech Coloproctol 10:11–15
Boccasanta P, Venturi M, Salamina G, Cesana BM, Bernasconi F, Roviaro G (2004) New trends in the surgical treatment of outlet obstruction: clinical and functionals results of two novel transanale stapled techniques from a randomized controlled trial. Int J Colorectal Dis 19:359–369
Pescatori M, Seow CF (2003) Use and abuse of new technologies in colorectal surgery. Tech Coloproctol 7:1–2
Sielezneff I, Malouf A, Cesari J, Brunet C, Sarles JC, Sastre B (1999) Selection criteria for internal rectal prolapse repair by Delorme’s transrectal excision. Dis Colon Rectum 42:367–373
Scaglia M, Fasth S, Hallgren T, Nordgren S, Oresland T, Hultén L (1994) Abdominal rectopexy for rectal prolapse. Influence of surgical technique on functional outcome. Dis Colon Rectum 37:805–813
Zacharakis E, Pramateftakis MG, Kanellos D, Kanellos I, Betsis D (2007) Long-term results after transanal stapled excixion of rectal internal mucosal prolapse. Tech Coloproctol 11:67–68
Dodi G, Pietroletti R, Milito G, Binda GA, Pescatori M (2003) Bleeding, incontinence, pain and constipation after STARR transanal double stapling rectotomy for obstructed defecation. Tech Coloproctol 7:148–153
Bassi R, Rademacher J, Savoia A (2006) Rectovaginal fistula after STARR procedure complicated by haematoma of the posterior vaginal wall: report of a case. Tech Coloproctol 10:361–363
Devroede G (1994) Psychological considerations in subjects with chronic idiopathic constipation. In: Wexner SD, Bartolo DCC (eds) Constipation: etiology, evaluation & management. Butterworth Heinemann, London
Miliacca C, Lombardi AM, Bilali S, Pescatori M (2006) The “Draw-a-family” test in the evaluation of patients with colorectal diseases. Pelvi-Perin RICP 25:15–18
Ayabaca SM, Zbar AP, Pescatori M (2002) Anal continence after rectocele repair. Dis Colon Rectum 45:63–69
Block JR (1986) Transrectal repair of rectocele using obliterative suture. Dis Colon Rectum 29:707–711
Sarles JC, Arnaud A, Selezneff I, Olivier S (1989) Endo-rectal repair of rectocele. Int J Colorectal Dis 4:167–171
Pescatori M, Interisano A, Stolfi VM, Zoffoli M (1998) Delorme’s operation and sphincteroplasty for rectal prolapse and faecal incontinence. Int J Colorectal Dis 13:223–224
Boccasanta P, Venturi M, Stuto A, Bottini C, Caviglia A, Carriero A, Mascagni D, Mauri R, Sofo L, Landolfi V (2004) Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial. Dis Colon Rectum 47:1285–1296
Puigdollers A, Fernandez-Fraga X, Azpiroz F (2007) Persistent symptoms of functional outlet obstruction after rectocele repair. Colorectal Dis 9:262–265
Khaikin M, Wexner SD (2006) Treatment strategies in obstructed defecation and fecal incontinence. World J Gastroenterol 12:3168–3173
Corman ML, Carriero A, Hager T, Herold A, Jayne DG, Lehur PA, Lomanto D, Longo A, Mellgren AF, Nicholls J, Nyström PO, Senagore AJ, Stuto A, Wexner SD (2006) Consesus conference on the stapled transanale rectal resection (STARR) for disorders defecaetion. Colorectal Dis 8:98–101
Tjandra JJ, Chan MK (2007) Systematic review on the procedure for prolapse and hemorrhoids (stapled haemorrhoidopexy). Dis Colon Rectum 50:878–892
Arroyo A, Perez-Vicente F, Serrano P, Serrano P, Sánchez A, Miranda E, Navarro JM, Candela F, Calpena R (2007) Evaluation of stapled transanal rectal resection technique with two staplers in the treatment of obstructive defecation syndrome. J Am Coll Surg 204:56–63
Yoshioka K, Keighley MR (1989) Clinical results of colectomy for severe constipation. Br J Surg 76:600–604
von Papen M, Ashari LH, Lumley JW, Stevenson AR, Stitz RW (2007) Functional results of laparoscopic resection rectopexy for symptomatic rectal intussusception. Dis Colon Rectum 50:50–55
Kruyt R, Delemarre J, Gooszen H, Vogel H (1990) Selection of patients with internal intussusception of the rectum for posterior rectopexy. Br J Surg 77:1183–1184
Tets W, Kuijpers J (1995) Internal rectal intussusception: fact or fancy? Dis Colon Rectum 38:1080–1083
American College of Gastroenterology Constipation Task Force (2005) An evidence-based approach to the management of chronic constipation in North America. Am J Gastroenterol 100(Suppl 1):S1–S4
Brandt LJ, Prather CM, Quigley EMM, Schiller L, Schoenfeld P, Talley NJ (2005) Systematic review on the management of chronic constipation in North America. Am J Gastroenterol 100(Suppl 1):S5–S21
Orrom W, Bartolo D, Miller R, Mortensen N, Roe A (1991) Rectopexy is an ineffective treatment for obstructed defecation. Dis Colon Rectum 34:41–46
McCue J, Thomson J (1990) Rectopexy for internal rectal intussusception. Br J Surg 77:632–634
Christiansen J, Zhu B, Rasmussen O, Sørensen M (1992) Internal rectal intussusception: results of surgical repair. Dis Colon Rectum 35:1026–1029
Schultz I, Mellgren A, Dolk A, Johansson C, Holmström B (2000) Long-term results and functional outcome after Ripstein rectopexy. Dis Colon Rectum 2000 43:35–43
Kellokumpu I, Vironen J, Scheinin T (2000) Laparoscopic repair of rectal prolapse. Surg Endosc 14:634–640
Johnson E, Carlsen E, Mjåland O, Drolsum A (2002) Resection rectopexy for internal rectal intussusception reduces constipation and incomplete evacuation of stool. Eur J Surg 588:51–56
Tsiaoussis J, Chrysos E, Athanasakis E et al (2005) Rectoanal intussusception: presentation of the disorder and late results of resection rectopexy. Dis Colon Rectum 48:838–844
Christiansen J, Hesselfeldt P, Sørensen M (1995) Treatment of internal rectal intussusception in patients with chronic constipation. Scand J Gastroenterol 30:470–472
Slim K, Mezoughi S, Launay-Savary MV, Tuech JJ, Michot F, Sielezneff I, Sastre B, Pigot F, Juguet F, Faucheron JL, Voirin D, Chipponi J (2008) Repair of rectocele using the Stapled TransAnal Rectal Resection (STARR) technique: intermediate results from a multicenter French study. J Chir (Paris) 145:27–31
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pescatori, M., Milito, G., Fiorino, M. et al. Complications and reinterventions after surgery for obstructed defecation. Int J Colorectal Dis 24, 951–959 (2009). https://doi.org/10.1007/s00384-009-0639-9
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-009-0639-9