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Tailored prolapse surgery for the treatment of haemorrhoids and obstructed defecation syndrome with a new dedicated device: TST STARR Plus

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Objective

The aim of the study was to assess the safety, efficacy and feasibility of stapled transanal procedures performed by a new dedicated device, TST STARR Plus, for tailored transanal stapled surgery.

Methods

All the consecutive patients admitted to eight referral centres affected by prolapses with III-IV degrees haemorrhoids or obstructed defecation syndrome (ODS) with rectocele and/or rectal intussusception that underwent stapled transanal resection with TST STARR plus were included in the present study. Haemostatic stitches for bleeding of the suture line, specimen volume, operative time, hospital stay and perioperative complications were recorded.

Results

From 1 November 2012 to 31 March 2013, 160 consecutive patients (96 females) were enrolled in the study. In 94 patients, the prolapse was over the half of the circular anal dilator (CAD). The mean duration of the procedure was 25 min. The mean resected volume of the specimen was 13.3 cm3, the mean hospital stay was 2.2 days. In 88 patients (55 %), additional stitches on the suture line were needed (mean 2.1). Suture line dehiscence was reported in four cases, with intraoperative reinforcement. Bleeding was reported in seven patients (5 %). Urgency after 30 days was reported in one patient. No major complication occurred.

Conclusions

The new device seems to be safe and effective for a tailored approach to anorectal prolapse due to haemorrhoids or obstructed defecation.

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References

  1. Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97

    Article  CAS  PubMed  Google Scholar 

  2. Agachan F, Chen T, Pfeifer J, Reissman P, Wexned SD (1996) A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 39:681–685

    Article  CAS  PubMed  Google Scholar 

  3. Longo A (1998 June 3–6) Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. In: Proceedings of the 6th World Congress of Endoscopic Surgery. Rome

  4. Renzi A, Brillantino A, Di Sarno G, D'Aniello F, Giordano A, Stefanuto A, Aguzzi D, Daffinà A, Ceci F, D'Oriano G, Mercuri M, Alderisio A, Perretta L, Carrino F, Sernia G, Greco E, Picchio M, Marino G, Goglia A, Trombetti A, De Pascalis B, Panella S, Bochicchio O, Bandini A, Del Re L, Longo F, Micera O (2011) PPH-01 versus PPH-03 to perform STARR for the treatment of hemorrhoids associated with large internal rectal prolapse: a prospective multicenter randomized trial. Surg Innov 18:241–247

    Article  PubMed  Google Scholar 

  5. Boccasanta P, Venturi M, Roviaro G (2011) What is the benefit of a new stapler device in the surgical treatment of obstructed defecation? Three-year outcomes from a randomized controlled trial. Dis Colon Rectum 54:77–84

    Article  PubMed  Google Scholar 

  6. Ommer A, Rolfs TM, Walz MK (2010) Long-term results of stapled transanal rectal resection (STARR) for obstructive defecation syndrome. Int J Colorectal Dis 25:1287–1292

    Article  PubMed  Google Scholar 

  7. Jayne DG, Schwandner O, Stuto A (2009) Stapled transanal rectal resection for obstructed defecation syndrome: one-year results of the European STARR Registry. Dis Colon Rectum 52:1205–1212

    Article  CAS  PubMed  Google Scholar 

  8. Lenisa L, Schwandner O, Stuto A, Jayne D, Pigot F, Tuech JJ, Scherer R, Nugent K, Corbisier F, Espin-Basany E, Hetzer FH (2009) STARR with Contour Transtar: prospective multicentre European study. Colorectal Dis 11:821–827

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Arroyo A, González-Argenté FX, García-Domingo M, Espin-Basany E, De-la-Portilla F, Pérez-Vicente F, Calpena R (2008) Prospective multicentre clinical trial of stapled transanal rectal resection for obstructive defaecation syndrome. Br J Surg 95:1521–1527

    Article  CAS  PubMed  Google Scholar 

  10. 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

    Article  PubMed  Google Scholar 

  11. Boccasanta P, Venturi M, Salamina G, Cesana BM, Bernasconi F, Roviaro G (2004) New trends in the surgical treatment of outlet obstruction: clinical and functional results of two novel transanal stapled techniques from a randomised controlled trial. Int J Colorectal Dis 19:359–369

    Article  PubMed  Google Scholar 

  12. Gravié JF, Lehur PA, Huten N, Papillon M, Fantoli M, Descottes B, Pessaux P, Arnaud JP (2005) Stapled hemorrhoidopexy versus milligan-morgan hemorrhoidectomy: a prospective, randomized, multicenter trial with 2-year postoperative follow up. Ann Surg 242:29–35

    Article  PubMed Central  PubMed  Google Scholar 

  13. Senagore AJ, Singer M, Abcarian H, Fleshman J, Corman M, Wexner S, Nivatvongs S (2004) Procedure for Prolapse and Hemmorrhoids (PPH) Multicenter Study Group. A prospective, randomized, controlled multicenter trial comparing stapled hemorrhoidopexy and Ferguson hemorrhoidectomy: perioperative and one-year results. Dis Colon Rectum 47(11):1824–1836

    Article  CAS  PubMed  Google Scholar 

  14. Correa-Rovelo JM, Tellez O, Obregón L, Miranda-Gomez A, Moran S (2002) Stapled rectal mucosectomy vs. closed hemorrhoidectomy: a randomized, clinical trial. Dis Colon Rectum 45:1367–1374

    Article  PubMed  Google Scholar 

  15. Boccasanta P, Capretti PG, Venturi M, Cioffi U, De Simone M, Salamina G, Contessini-Avesani E, Peracchia A (2001) Randomised controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse. Am J Surg 182:64–68

    Article  CAS  PubMed  Google Scholar 

  16. Ho YH, Cheong WK, Tsang C, Ho J, Eu KW, Tang CL, Seow-Choen F (2000) Stapled hemorrhoidectomy–cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months. Dis Colon Rectum 43:1666–1675

    Article  CAS  PubMed  Google Scholar 

  17. Naldini G (2011) Serious unconventional complications of surgery with stapler for haemorrhoidal prolapse and obstructed defaecation because of rectocoele and rectal intussusception. Colorectal Dis 13:323–327

    Article  CAS  PubMed  Google Scholar 

  18. Wadhawan H, Shorthouse AJ, Brown SR (2010) Surgery for obstructed defaecation: does the use of the Contour device (Trans-STARR) improve results? Colorectal Dis 12:885–890

    Article  CAS  PubMed  Google Scholar 

  19. Boccasanta P, Venturi M, Roviaro G (2007) Stapled transanal rectal resection versus stapled anopexy in the cure of hemorrhoids associated with rectal prolapse. A randomized controlled trial. Int J Colorectal Dis 22:245–251

    Article  PubMed  Google Scholar 

  20. Naldini G, Martellucci J, Talento P, Caviglia A, Moraldi L, Rossi M (2009) New approach to large haemorrhoidal prolapse: double stapled haemorrhoidopexy. Int J Colorectal Dis 24:1383–1387

    Article  PubMed  Google Scholar 

  21. Braini A, Narisetty P, Favero A, Calandra S, Calandra A, Caponnetto F, Digito F, Da Pozzo F, Marcotti E, Porebski E, Rovedo S, Terrosu G, Torricelli L, Stuto A (2013 Jan 20) Double PPH technique for hemorrhoidal prolapse: a multicentric, prospective, and nonrandomized trial. Surg Innov. PubMed PMID: 23339147

  22. Stuto A, Favero A, Cerullo G, Braini A, Narisetty P, Tosolini G (2012) Double stapled haemorrhoidopexy for haemorrhoidal prolapse: indications, feasibility and safety. Colorectal Dis 14:e386–e389

    Article  CAS  PubMed  Google Scholar 

  23. Naldini G, Martellucci J, Moraldi L, Romano N, Rossi M (2009) Is simple mucosal resection really possible? Considerations about histological findings after stapled hemorrhoidopexy. Int J Colorectal Dis 24:537–541

    Article  PubMed  Google Scholar 

  24. Festen S, Molthof H, van Geloven AA, Luchters S, Gerhards MF (2012) Predictors of recurrence of prolapse after procedure for prolapse and haemorrhoids. Colorectal Dis 14:989–996

    Article  CAS  PubMed  Google Scholar 

  25. Pescatori M, Gagliardi G (2008) Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Tech Coloproctol 12:7–19

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. FDA (2012) General Hospital Devices and Supplies. Surg Innov 20:553–558

  27. Arroyo A, Pérez-Vicente F, Miranda E, Sánchez A, Serrano P, Candela F, Oliver I, Calpena R (2006) Prospective randomized clinical trial comparing two different circular staplers for mucosectomy in the treatment of hemorrhoids. World J Surg 30:1305–1310

    Article  PubMed  Google Scholar 

  28. Giuratrabocchetta S, Pecorella G, Stazi A, Tegon G, De Fazio M, Altomare DF (2013) Safety and short-term effectiveness of EEA stapler vs PPH stapler in the treatment of degree III haemorrhoids: prospective randomized controlled trial. Colorectal Dis 15:354–358

    Article  CAS  PubMed  Google Scholar 

  29. Dindo D, Hahnloser D (2013) Anal mucosectomy for haemorrhoids: should we start to speak Chinese? Colorectal Dis 15:e186–e189

    Article  CAS  PubMed  Google Scholar 

  30. Petersen S, Schinkel B, Jürgens S, Taylessani C, Schwenk W (2013) Impact of prolapse mass on Contour(®) Transtar™ technique for third-degree rectal prolapse. Int J Colorectal Dis 28:1027–1030

    Article  PubMed  Google Scholar 

  31. Martellucci J, Naldini G, Del Popolo G, Carriero A (2012) Sacral nerve modulation in the treatment of chronic pain after pelvic surgery. Colorectal Dis 14:502–507

    Article  CAS  PubMed  Google Scholar 

Download references

Competing interests

The authors have no potential conflict of interests to be disclosed.

Author information

Authors and Affiliations

  1. Proctological and Perineal Surgery, University Hospital of Pisa, Pisa, Italy

    Gabriele Naldini & Claudia Menconi

  2. General, Emergency and Minimally Invasive Surgery I, Careggi University Hospital, Florence, Italy

    Jacopo Martellucci

  3. General Surgery Department, Clinica Mediterranea, Naples, Italy

    Roberto Rea

  4. General Surgery Department, Castel S. Giovanni Hospital, Piacenza, Italy

    Stefano Lucchini

  5. General Surgery Department, S. Maria dei Battuti Hospital, Conegliano, Treviso, Italy

    Michele Schiano di Visconte

  6. Colonproctology Surgery Unit, San Camillo-Forlanini Hospital, Rome, Italy

    Angelo Caviglia

  7. Proctological Surgery, Gastric and Intestine Hospital, Sun Yi San University, Guangzhou Hospital, Guangzhou, China

    Donglin Ren

  8. Proctological Surgery, Colorectal Hospital, Chengdu Traditional Chinese Medicine University, Chengdu, China

    Ping He

  9. Surgical Science Department, La Sapienza University, Rome, Italy

    Domenico Mascagni

Authors
  1. Gabriele Naldini
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  2. Jacopo Martellucci
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  3. Roberto Rea
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  4. Stefano Lucchini
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  5. Michele Schiano di Visconte
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  6. Angelo Caviglia
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  7. Claudia Menconi
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  8. Donglin Ren
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  9. Ping He
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  10. Domenico Mascagni
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Corresponding author

Correspondence to Jacopo Martellucci.

Additional information

What does this paper add to the literature?

This is the first study analyzing this new device for prolapse surgery. In this prospective, multicentric study, the safety and the efficacy of the new stapler were evaluated, with convincing results. An improvement in the stapler closure system, the open case with mega windows and an improved staple line were considered essential for a reduction of recurrences and complications.

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Naldini, G., Martellucci, J., Rea, R. et al. Tailored prolapse surgery for the treatment of haemorrhoids and obstructed defecation syndrome with a new dedicated device: TST STARR Plus. Int J Colorectal Dis 29, 623–629 (2014). https://doi.org/10.1007/s00384-014-1845-7

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  • DOI: https://doi.org/10.1007/s00384-014-1845-7

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