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Stapled transanal rectal resection for the treatment of rectocele associated with obstructed defecation syndrome: a large series of 262 consecutive patients

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Abstract

Background

This study aims to investigate functional results and recurrence rate after stapled transanal rectal resection (STARR) for rectocele associated with obstructive defection syndrome (ODS).

Methods

A study was conducted on patients with ODS symptoms associated with symptomatic rectocele ≥ 3 cm on dynamic defecography who had STARR at our institution between 01/2007 and 12/2015. Data were prospectively collected and analyzed. ODS was evaluated using the Wexner constipation score. Primary outcomes were functional results, determined by the improvement in 6-month postoperative Wexner constipation score, and 1-year recurrence. Secondary outcomes were operative time, time to return to work, pain intensity measured using the visual analogue scale (VAS), patient satisfaction, and overall postoperative morbidity and mortality at 30 days.

Results

Two-hundred-sixty-two consecutive female patients [median age 54 years (range 20–78)] were enrolled in the study. The median duration of follow-up was 79 months (range 30–138). Sixty (23%) patients experienced postoperative complications, but only 9 patients required reinterventions for surgical hemostasis (n = 7), fecal diversion for anastomotic leakage (n = 1), and recto-vaginal fistula repair (n = 1). Only 1 intraoperative complication (stapler misfire) was reported, and there were no deaths. There was a statistically significant (p < 0.001) reduction in the median (range) Wexner constipation score from 19 (14–24) preoperatively to 9 (5–15) 6 months postoperatively. Only 10 (4%) patients experienced recurrence and only 3 of them required additional reintervention. Patient satisfaction at 1 year was excellent in 86%, good in 13%, and poor in 1% of patients.

Conclusions

STARR is a safe, effective, and minimally invasive technique for the treatment of rectocele associated with ODS.

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Data availability

The datasets during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of General Surgery, Villa Tiberia Hospital, Via Emilio Praga, 26, 00100, Rome, Italy

    G. Giarratano, C. Toscana & E. Toscana

  2. Colorectal Surgery Unit, Department of General Surgery, Mansoura University, Mansoura, Dakahlia, Egypt

    M. Shalaby

  3. Department of General Surgery, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy

    M. Shalaby & P. Sileri

Authors
  1. G. Giarratano
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  2. C. Toscana
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  3. E. Toscana
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  4. M. Shalaby
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  5. P. Sileri
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Correspondence to E. Toscana.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained for the surgical procedure prior to their participation.

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Giarratano, G., Toscana, C., Toscana, E. et al. Stapled transanal rectal resection for the treatment of rectocele associated with obstructed defecation syndrome: a large series of 262 consecutive patients. Tech Coloproctol 23, 231–237 (2019). https://doi.org/10.1007/s10151-019-01944-9

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