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Results, Outcome Predictors, and Complications after Stapled Transanal Rectal Resection for Obstructed Defecation

  • Original Contribution
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Diseases of the Colon & Rectum

Abstract

Purpose

Obstructed defecation may be treated by stapled transanal rectal resection, but different complications and recurrence rates have been reported. The present study was designed to evaluate stapled transanal rectal resection results, outcome predictive factors, and nature of complications.

Methods

Clinical and functional data of 123 patients were retrospectively analyzed. All patients had symptoms of obstructed defecation before surgery and had rectocele and/or intussusception. Of them, 85 were operated on by the authors and 38 were referred after stapled transanal rectal resection had been performed elsewhere.

Results

At a median follow-up of 17 (range, 3–44) months, 65 percent of the patients operated on by the authors had subjective improvement. Recurrent rectocele was present in 29 percent and recurrent intussusception was present in 28 percent of patients. At univariate analysis, results were worse in those with preoperative digitation (P < 0.01), puborectalis dyssynergia (P < 0.05), enterocele (P < 0.05), larger size rectocele (P < 0.05), lower bowel frequency (P < 0.05), and sense of incomplete evacuation (P < 0.05). Bleeding was the most common perioperative complication occurring in 12 percent of cases. Reoperations were needed in 16 patients (19 percent): 9 for recurrent disease. In the 38 patients referred after stapled transanal rectal resection, the most common problems were perineal pain (53 percent), constipation with recurrent rectocele and/or intussusception (50 percent), and incontinence (28 percent). Of these patients, 14 (37 percent) underwent reoperations: 7 for recurrence. Three patients presented with a rectovaginal fistula. One other patient died for necrotizing pelvic fasciitis.

Conclusions

Stapled transanal rectal resection achieved acceptable results at the cost of a high reoperation rate. Patients with puborectalis dyssynergia and lower bowel frequency may do worse because surgery does not address the causes of their constipation. Patients with large rectoceles, enteroceles, digitation, and a sense of incomplete evacuation may have more advanced pelvic floor disease for which stapled transanal rectal resection, which simply removes redundant tissue, may not be adequate. This, together with the complications observed in patients referred after stapled transanal rectal resection, suggests that this procedure should be performed by colorectal surgeons and in carefully selected patients.

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Acknowledgements

The authors thank Drs. F. Bianco, M. Gargiani, and G. Tessera for their help with data collection.

Author information

Authors and Affiliations

  1. General Surgery, Clinica Pineta Grande, Via Domiziana Km. 30, Castel Volturno (Caserta), 81030, Italy

    Giuseppe Gagliardi M.D.

  2. Coloproctology Unit, Villa Flaminia Hospital, Rome, Italy

    Mario Pescatori M.D., F.R.C.S., E.B.S.Q.

  3. Department of Emergency and Organ Transplantation, General Surgery and Liver Transplantation Unit, University of Bari, Bari, Italy

    Donato F. Altomare M.D. & Marcella Rinaldi M.D.

  4. Coloproctology Unit, Ospedale Galliera, Genoa, Italy

    Gian Andrea Binda M.D.

  5. Coloproctology Unit, Ospedale S. Antonio Abate, Gallarate, Varese, Italy

    Corrado Bottini M.D.

  6. Coloproctology Unit, University of Padua, Padua, Italy

    Giuseppe Dodi M.D.

  7. General Surgery, Ospedale S. Eugenio, Rome, Italy

    Vincenzino Filingeri M.D.

  8. Coloproctology Unit, University of Rome Tor Vergata, Rome, Italy

    Giovanni Milito M.D.

  9. Coloproctology Unit, Ospedale Moscati, Avellino, Italy

    Giovanni Romano M.D.

  10. Center of Biometric and Medical Statistics INRCA - Ancona, Ancona, Italy

    Liana Spazzafumo M.S.

  11. Coloproctology Unit, Clinica S. Gaudenzio, Novara, Italy

    Mario Trompetto M.D.

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  1. Giuseppe Gagliardi M.D.
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  2. Mario Pescatori M.D., F.R.C.S., E.B.S.Q.
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  6. Giuseppe Dodi M.D.
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on behalf of the Italian Society of Colo-Rectal Surgery (SICCR)

Corresponding author

Correspondence to Giuseppe Gagliardi M.D..

Additional information

Read at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 3 to 7 2006.

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Gagliardi, G., Pescatori, M., Altomare, D.F. et al. Results, Outcome Predictors, and Complications after Stapled Transanal Rectal Resection for Obstructed Defecation. Dis Colon Rectum 51, 186–195 (2008). https://doi.org/10.1007/s10350-007-9096-0

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  • DOI: https://doi.org/10.1007/s10350-007-9096-0

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