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Stapled Transanal Rectal Resection for Outlet Obstruction Syndrome: Results and Follow-up

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Abstract

Background

The objective of the present study was to assess safety, effectiveness, and long-term outcomes of stapled transanal rectal resection (STARR) for the cure of outlet obstruction syndrome (OOS).

Methods

Data were collected over a 3-year period (2004–2007), at the Department of Surgery of the University of Genoa, from 25 consecutive subjects (19 of them females) undergoing STARR because of OOS that had not responded to medical treatment,.

Results

Preoperatively, patients were submitted to clinical examination, defecography, colonoscopy, manometry, and recto-anal reflexes determination. All patients had mucosal prolapse, 15 rectal intussusception, 15 rectocele. Postoperatively no deaths were observed; one patient had a hemorrhage requiring reintervention. Mean time to resumption of normal activity was 8.5 ± 4.5 days. Patients were followed for a mean of 24.7 ± 10.9 months (range: 6–42 months). Late specific complications included 3 cases of urge to defecate, 8 of incontinence to flatus. Functional outcome was positive for 22 patients (excellent in 4 cases, good in 15, fairly good in 3). Six months postoperatively (25 s), patients had improvement of the mean Constipation Score (p = 0.0002), less pain during evacuation (p = 0.0003), and reduced use of digital assistance to defecate (p < 0.0001). Continence Grading Scale and enema use remained stable after intervention. Patients had increase in basal sphincter pressure (p = 0.0078) and maximal squeeze pressure (p = 0.0051). Recto-anal reflex study showed increase in abdominal pain threshold (p < 0.0001); anal sphincter relaxation threshold and desire to defecate threshold did not change.

Conclusions

According to the present study, STARR seemed to be a safe and effective treatment for OOS associated with symptomatic rectocele and intussusception.

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Authors and Affiliations

  1. Department of Surgery, University of Genoa, Di.C.M.I., Largo Rosanna Benzi 8, Genoa, 16132, Italy

    Marco Frascio, Cesare Stabilini, Barbara Ricci, Rosario Fornaro, Luigi De Salvo, Francesca Mandolfino, Fabrizio Lazzara & Ezio Gianetta

  2. Ospedale San Martino, U. O. di Radiologia, Genova, Italy

    Paolo Marino

Authors
  1. Marco Frascio
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  2. Cesare Stabilini
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  3. Barbara Ricci
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  4. Paolo Marino
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  5. Rosario Fornaro
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  6. Luigi De Salvo
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  7. Francesca Mandolfino
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  8. Fabrizio Lazzara
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  9. Ezio Gianetta
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Correspondence to Cesare Stabilini.

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Frascio, M., Stabilini, C., Ricci, B. et al. Stapled Transanal Rectal Resection for Outlet Obstruction Syndrome: Results and Follow-up. World J Surg 32, 1110–1115 (2008). https://doi.org/10.1007/s00268-008-9540-x

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  • DOI: https://doi.org/10.1007/s00268-008-9540-x

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