Skip to main content

Advertisement

SpringerLink
Log in

Results in the long-term course after stapled transanal rectal resection (STARR)

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Stapled transanal rectal resection (STARR) has recently been recommended for patients with obstructed defecation caused by rectocele and rectal wall intussusception. Our study investigates the long-term results and predictive factors for outcome.

Methods

Between November 2002 and February 2007, 80 patients (69 females) were operated on using the STARR procedure and included in the following study. Symptoms were defined according to the ROME II criteria. Preoperative assessment included clinical examination, colonoscopy, video defecography, and dynamic MRI. Preoperatively and during follow-up visits, we evaluated the Cleveland Constipation Score (CCS) to rate the severity of outlet obstruction and the Wexner Incontinence Score to rate anal incontinence. Patients were asked to judge the outcome of the operation as improved or poor/dissatisfied. We performed a univariate analysis for 11 patient- and disease-related factors to detect an association with outcome.

Results

The median follow-up was 39 months (range 20–78). Major postoperative complications (one staple line insufficiency, one urosepsis, one prolonged urinary dysfunction with indwelling catheter) were found in 3.8%. The result after STARR procedure was a success in the long-term follow-up in 62 patients (77.5%), although the improvement did not persist in 15 patients (18.7%). The mean value of the CCS decreased significantly from 9.3 before surgery to 4.6 after 2 years and increased again slightly to 6.5 after 4–6 years. The Median Wexner Incontinence Score was 3.3 at baseline, but rose significantly to 6.0. However, a third of patients who reported deteriorated continence developed the symptoms 1–4 years after surgery. Of the factors investigated for the prediction of outcome, we could only identify the number of pelvic floor changes in defecography or dynamic MRI as being associated with the success of the operation.

Conclusion

Our study indicates that STARR is a safe procedure. A significant improvement of symptoms is to be expected, but this improvement may deteriorate with time. Patients’ satisfaction is also associated with the occurrence of urge to defecate or incontinence. It remains difficult to predict outcome

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Herold A (2006) Colorectal classification of pelvic floor dysfunctions. Viszeralchirurgie 41:163–168

    Article  Google Scholar 

  2. Ommer A, Albrecht K, Wenger F, Walz MK (2006) Stapled transanal rectal resection (STARR): a new option in the treatment of obstructive defecation syndrome. Langenbeck’s Arch Surg 391(1):32–37

    Article  CAS  Google Scholar 

  3. 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) Consensus conference on the stapled transanal rectal resection (STARR) for disordered defaecation. Dis Colon Rectum 8(2):98–101

    CAS  Google Scholar 

  4. Liberman H, Hughes C, Dippolito A (2000) Evaluation and outcome of the Delorme procedure in the treatment of rectal outlet obstruction. Dis Colon Rectum 43:188–192

    Article  PubMed  CAS  Google Scholar 

  5. Tsiaoussis J, Chrysos E, Athanaskis E, Pechlivanides G, Tzortzinis A, Zoras O, Xynos E (2005) Rectoanal intussusception: presentation of the disorder and late results of resection rectopexy. Dis Colon Rectum 48:838–844

    Article  PubMed  Google Scholar 

  6. Bruch H, Herold A, Schiedeck T, Schwandner O (1999) Laparoscopic surgery for rectal prolapse and outlet obstruction. Dis Colon Rectum 42(9):1189–1194

    Article  PubMed  CAS  Google Scholar 

  7. Schiedeck T, Schwandner O, Scheele J, Farke S, Bruch H (2005) Rectal prolapse: which surgical option is appropriate? Langenbeck’s Arch Surg 390(1):8–14

    Article  CAS  Google Scholar 

  8. Huber F, Stein H, Siewert J (1995) Functional results after treatment of rectal prolapse with rectopexy and sigmoid resection. World J Surg 19(1):138–143

    Article  PubMed  CAS  Google Scholar 

  9. Portier G, Iovino F, Lazorthes F (2006) Surgery for rectal prolapse: Orr-Loygue ventral rectopexy (OlvR) with limited dissection prevents postoperative induced constipation without increasing recurrence. Dis Colon Rectum 49(8):1136–1140

    Article  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 47:1285–1297

    Article  PubMed  Google Scholar 

  11. Longo A (1998) Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. In: Proc. of the 6th World Congress of Endoscopy Surgery. pp 777–784

  12. Gagliardi G, Pescatori M, Altomare DF, Binda GA, Bottini C, Dodi G, Filingeri V, Milito G, Rinaldi M, Romano G, Spazzafumo L, Trompetto M (2007) Results, outcome predictors, and complications after stapled transanal rectal resection for obstructed defecation. Dis Colon Rectum 51(2):186–195

    Article  PubMed  Google Scholar 

  13. 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  PubMed  CAS  Google Scholar 

  14. Frascio M, Stabilini C, Ricci B, Marino P, Fornaro R, Salvo LD, Mandolfino F, Lazzara F, Gianetta E (2008) Stapled transanal rectal resection for outlet obstruction syndrome: results and follow-up. World J Surg 32:1110–1115

    Article  PubMed  Google Scholar 

  15. Petersen S, Hellmich G, Schuster A, Lehmann D, Albert W, Ludwig K (2006) Stapled transanal rectal resection under laparoscopic surveillance for rectocele and concomitant enterocele. Dis Colon Rectum 49:685–689

    Article  PubMed  CAS  Google Scholar 

  16. Schwandner O (2004) Differential diagnosis in descending perineum syndrome. Chirurg 75(9):850–860

    Article  PubMed  CAS  Google Scholar 

  17. Agachan F, Pfeiffer J, Wexner S (1996) Defecography and proctography. Results of 744 patients. Dis Colon Rectum 39(8):899–905

    Article  PubMed  CAS  Google Scholar 

  18. Nielsen M, Burron B, Christiansen J, Hegedüs V (1993) Defecographic findings in patients with anal incontinence and constipation and their relation to rectal emptying. Dis Colon Rectum 36(9):806–809

    Article  PubMed  CAS  Google Scholar 

  19. Weiss EG, McLemore EC (2008) Functional disorders: rectoanal intussusception. Clin Colon Rectal Surg 21(2):122–128

    Article  PubMed  Google Scholar 

  20. Dvorkin LS, Knowles CH, Scott SM, Williams NS, Lunniss PJ (2005) Rectal intussusception: characterization of symptomatology. Dis Colon Rectum 48:824–831

    Article  PubMed  Google Scholar 

  21. Shin EJ (2011) Surgical treatment of rectal prolapse. J Korean Soc Coloproctol 27(1):5–12

    Article  PubMed  Google Scholar 

  22. Hammond K, Beck DE, Margolin DD, Whitlow CB, Timmcke AE, Hicks TC (2007) Rectal prolapse: a 10-year experience. Ochsner J 7(1):24–32

    PubMed  Google Scholar 

  23. Cirocco WC (2010) The Altemeier procedure for rectal prolapse: an operation for all ages. Dis Colon Rectum 53(12):1618–1623

    Article  PubMed  Google Scholar 

  24. Wilson J, Engledow A, Crosbie J, Arulampalam T, Motson R (2011) Laparoscopic nonresectional suture rectopexy in the management of full-thickness rectal prolapse: substantive retrospective series. Surg Endosc 25:1062–1064

    Article  PubMed  Google Scholar 

  25. Laubert T, Kleemann M, Schorcht A, Czymek R, Jungbluth T, Bader FG, Bruch H-P, Roblick UJ (2010) Laparoscopic resection rectopexy for rectal prolapse: a single center study during 16 years. Surg Endosc 24:2401–2406

    Article  PubMed  Google Scholar 

  26. Wald A (2001) Outlet dysfunction constipation. Curr Treat Options Gastroenterol 4(4):293–297

    Article  PubMed  Google Scholar 

  27. Ho Y, Tan M, Goh H (1996) Clinical and physiologic effects of biofeedback in outlet obstruction constipation. Dis Colon Rectum 39(5):520–524

    Article  PubMed  CAS  Google Scholar 

  28. Lehur PA, Stuto A, Fantoli M, Villani RD, Queralto M, Lazorthes F, Hershman M, Carriero A, Pigot F, Meurette G, Narisetty P, Villet R (2008) Outcomes of stapled transanal rectal resection vs. biofeedback for the treatment of outlet obstruction associated with rectal intussusception and rectocele: a multicenter, randomized, controlled trial. Dis Colon Rectum 51:1611–1618

    Article  PubMed  Google Scholar 

  29. Reboa G, Gipponi M, Logorio M, Marino P, Lantieri F (2009) The impact of stapled transanal rectal resection on anorectal function in patients with obstructed defecation syndrome. Dis Colon Rectum 52(9):1598–1604

    Article  PubMed  Google Scholar 

  30. Schwandner O, Fürst A (2010) Assessing the safety, effectiveness, and quality of life after the STARR procedure for obstructed defecation: results of the German STARR registry. Langenbeck’s Arch Surg 395(5):505–513

    Article  Google Scholar 

  31. 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(7):1205–1212

    Article  PubMed  CAS  Google Scholar 

  32. Zhang B, Ding J, Yin S, Zhang M, Zhao K (2010) Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception. World J Gastroenterol 16(20):2542–2548

    Article  PubMed  Google Scholar 

  33. Madbouly K, Abbas K, Hussein A (2010) Disappointing long-term outcomes after stapled transanal rectal resection for obstructed defecation. World J Surg 34(9):2191–2196

    Article  PubMed  Google Scholar 

  34. LiDestri G, Scilletta B, Tomaselli TG, Zarbo G (2008) Rectovaginal fistula: a new approach by stapled transanal rectal resection. J Gastrointest Surg 12(3):601–603

    Article  Google Scholar 

  35. Pescatori M, Dodi G, Salafia C, Zbar A (2005) Recto-vaginal fistulae after STARR procedure. Int J Colorectal Dis 20:83–85

    Article  PubMed  Google Scholar 

  36. Arroyo A, Gonzales-Argente F, Garcia-Domingo M, Espin-Basany E, De-la-Portilla F, Rerez-Vicente F, Calpena R (2008) Prospective multicentre clinical trial of stapled transanal rectal resection for obstructive defaecation syndrome. Br J Surg 95(12):1521–1527

    Article  PubMed  CAS  Google Scholar 

  37. Stuto A, Renzi A, Carriero A, Gabrielli F, Gianfreda V, Villani RD, Pietrantoni C, Seria G, Capomagi A, Talento P (2011) Stapled trans-anal rectal resection (STARR) in the surgical treatment of the obstructed defecation syndrome: results of the STARR Italian registry. Surg Innov 18(3):248–253

    Article  PubMed  Google Scholar 

  38. Altomare DF, Spazzafumo L, Rinaldi M, Dodi G, Ghiselli R, Piloni V (2008) Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome. Colorectal Dis 10:84–88

    PubMed  CAS  Google Scholar 

  39. Zehler O, Vashist Y, Bogoevski D, Bockhorn M, Yekebas E, Izbicki J, Kutup A (2010) Quo vadis STARR? A prospective long-term follow-up of stapled transanal rectal resection for obstructed defecation syndrome. J Gastrointest Surg 14(9):1349–1354

    Article  PubMed  Google Scholar 

  40. Slim K, Mezoughi S, Launay-Savary MV, Tuech J, Michot F, Sielezneff I, Sastre B, Pigot F, Juguet F, Faucheron J, 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(1):27–31

    Article  CAS  Google Scholar 

  41. Schwandner T, Hecker A, Hirschburger M, Hecker M, Kierer W, Padberg W (2011) Does the STARR procedure changes the pelvic floor: a preoperative and postoperative study with dynamic pelvic floor MRI. Dis Colon Rectum 54:412–417

    Article  PubMed  Google Scholar 

  42. Boenicke L, Jayne D, Kim M, Reibetanz J, Bolte R, Kenn W, Germer C, Isbert C (2011) What happens in stabled transanal rectum resection? Dis Colon Rectum 54:593–600

    Article  PubMed  Google Scholar 

  43. D’Hoore A, Cadoni R, Penninckx F (2004) Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg 91:1500–1505

    Article  PubMed  Google Scholar 

  44. D’Hoore A (2007) Laparoscopicventral rectopexy in symptomatic patients with rectal intussusception. New surgical techniques to correct rectal prolapse syndromes. Leuven University Press, Leuven

    Google Scholar 

  45. Penninckx F (2010) Surgery for internal rectal prolapse revisited. Colorectal Dis 12:83–84

    Article  PubMed  Google Scholar 

  46. Collinson R, Wijffels N, Cunningham C, Lindsey I (2010) Laparoscopic ventral rectopexy for internal rectal prolapse: short-term functional results. Colorectal Dis 12:97–104

    Article  PubMed  CAS  Google Scholar 

  47. Lang R, Buhmann S, Lautenschläger C, Müller M, Lienemann A, Jauch K, Kreis M (2010) Stapled transanal rectal resection for symptomatic intussusception: morphological and functional outcome. Surg Endosc 24(8):1969–1975

    Article  PubMed  Google Scholar 

  48. Jayne DG, Finan PJ (2005) Stapled transanal rectal resection for obstructed defecation and evidence-based practice. Br J Surg 92:793–794

    Article  PubMed  CAS  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of General and Visceral Surgery, Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, 01067, Dresden, Germany

    Katrin Köhler, Sigmar Stelzner, Gunter Hellmich, Thomas Jackisch, Bernhard Fankhänel & Helmut Witzigmann

  2. Department of Radiology, Dresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, D-01067, Dresden, Germany

    Dirk Lehmann

Authors
  1. Katrin Köhler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sigmar Stelzner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gunter Hellmich
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dirk Lehmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Jackisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bernhard Fankhänel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Helmut Witzigmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katrin Köhler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Köhler, K., Stelzner, S., Hellmich, G. et al. Results in the long-term course after stapled transanal rectal resection (STARR). Langenbecks Arch Surg 397, 771–778 (2012). https://doi.org/10.1007/s00423-012-0920-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-012-0920-1

Keywords

Search

Navigation