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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

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  • Published:
Diseases of the Colon & Rectum

An Erratum to this article was published on 26 September 2008

Abstract

Purpose

This study was designed to assess the safety and outcomes achieved with stapled transanal rectal resection vs. biofeedback training in obstructed defecation patients.

Methods

A total of 119 women patients who suffered from obstructed defecation with associated rectocele and rectal intussusception were randomized to stapled transanal rectal resection or biofeedback training. Stapled transanal rectal resection was performed by using two circular staplers to produce transanal full-thickness rectal resection. Primary outcome was symptoms of obstructed defecation resolution at 12 months; secondary outcomes included safety, change in quality of life score, and anatomic correction of rectocele and rectal intussusception.

Results

Fourteen percent (8/59) stapled transanal rectal resection and 50 percent (30/60) biofeedback training patients withdrew early. Eight (15 percent) patients treated with stapled transanal rectal resection and 1 (2 percent) biofeedback patient experienced adverse events. One serious adverse event (bleeding) occurred after stapled transanal rectal resection. Scores of obstructed defecation improved significantly in both groups as did quality of life (both P < 0.0001). Successful treatment was observed in 44 (81.5 percent) stapled transanal rectal resection vs. 13 (33.3 percent) evaluable biofeedback training patients (P < 0.0001). Functional benefit was observed early and remained stable during the study.

Conclusions

In this controlled trial, stapled transanal rectal resection was well tolerated, was more effective than biofeedback training for the resolution of obstructed defecation symptoms, and improved quality of life, with minimal risk of impaired continence. Thus, stapled transanal rectal resection offers a new treatment alternative for obstructed defecation after failure of conservative measures including biofeedback training, a noninvasive approach.

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References

  1. Talley NJ, Weaver AL, Zinsmeister AR, Melton LJ 3rd. Functional constipation and outlet delay: a population-based study. Gastroenterology 1993;105:781–90.

    PubMed  CAS  Google Scholar 

  2. Siproudhis L, Dautreme S, Ropert A, et al. Anismus and biofeedback: who benefits. Eur J Gastroenterol Hepatol 1995;7:547–52.

    PubMed  CAS  Google Scholar 

  3. van Dam JH, Hop WC, Schouten WR. Analysis of patients with poor outcome of rectocele repair. Dis Colon Rectum 2000;43:1556–60.

    Article  PubMed  Google Scholar 

  4. Mimura T, Roy AJ, Storrie JB, Kamm MA. Treatment of impaired defecation associated with rectocele by behavorial retraining (biofeedback). Dis Colon Rectum 2000;43:1267–72.

    Article  PubMed  CAS  Google Scholar 

  5. Boccasanta P, Venturi M, Calabro G, et al. Which surgical approach for rectocele? A multicentric report from Italian coloproctologists. Tech Coloproctol 2001;5:149–56.

    Article  PubMed  CAS  Google Scholar 

  6. Altomare DF, Rinaldi M, Veglia A, Petrolino M, De Fazio M, Sallustio P. Combined perineal and endorectal repair of rectocele by circular stapler: a novel surgical technique. Dis Colon Rectum 2002;45:1549–52.

    Article  PubMed  Google Scholar 

  7. Jayne DG, Finan PJ. Stapled transanal rectal resection for obstructed defaecation and evidence-based practice. Br J Surg 2005;92:793–4.

    Article  PubMed  CAS  Google Scholar 

  8. Corman ML, Carriero A, Hager T, et al. Consensus conference on the stapled transanal rectal resection (STARR) for disordered defaecation. Colorectal Dis 2006;8:98–101.

    Article  PubMed  CAS  Google Scholar 

  9. National Institute for Health and Clinical Excellence. Stapled transanal rectal resection for obstructed defaecation syndrome. Available at: http://guidance.nice.org.uk/IPG169/guidance/pdf/English/download.dspx. Accessed March 30, 2008.

  10. Amin AI, Hallbook O, Lee AJ, Sexton R, Moran BJ, Heald RJ. A 5-cm colonic J pouch colo-anal reconstruction following anterior resection for low rectal cancer results in acceptable evacuation and continence in the long term. Colorectal Dis 2003;5:33–7.

    Article  PubMed  CAS  Google Scholar 

  11. Boccasanta P, Venturi M, Stuto A, et al. Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial. Dis Colon Rectum 2004;47:1285–97.

    Article  PubMed  Google Scholar 

  12. Marquis P, De La Loge C, Dubois D, McDermott A, Chassany O. Development and validation of the Patient Assessment of Constipation Quality of Life questionnaire. Scand J Gastroenterol 2005;40:540–51.

    Article  PubMed  Google Scholar 

  13. Oliveira L, Pfeifer J, Wexner SD. Physiological and clinical outcome of anterior sphincteroplasty. Br J Surg 1996;83:502–5.

    Article  PubMed  CAS  Google Scholar 

  14. Anonymus. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2000;284:3043–5.

  15. Whitehead WE, Wald A, Diamant NE, Enck P, Pemberton JH, Rao SS. Functional disorders of the anus and rectum. Gut 1999;45(Suppl 2)II55–9.

    PubMed  Google Scholar 

  16. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Muller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut 1999;45(Suppl 2)II43–7.

    Article  PubMed  Google Scholar 

  17. Dodi G, Pietroletti R, Milito G, Binda G, Pescatori M. Bleeding, incontinence, pain and constipation after STARR transanal double stapling rectotomy for obstructed defecation. Tech Coloproctol 2003;7:148–53.

    Article  PubMed  CAS  Google Scholar 

  18. Boccasanta P, Venturi M, Salamina G, Cesana BM, Bernasconi F, Roviaro G. 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 2004;19:359–69.

    Article  PubMed  Google Scholar 

  19. Arroyo A, Perez-Vicente F, Serrano P, et al. Evaluation of the stapled transanal rectal resection technique with two staplers in the treatment of obstructive defecation syndrome. J Am Coll Surg 2007;204:56–63.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Aysgarth Statistics, Beaconsfield, United Kingdom, for statistical analysis, and Physicians World GmbH, Mannheim, Germany, for medical writing.

Author information

Authors and Affiliations

  1. Institut des Maladies de l’Appareil Digestif (IMAD), University Hospital of Nantes, Nantes, France

    Paul A. Lehur M.D. & Guillaume Meurette M.D.

  2. Ospedale Santa Maria degli Angeli, Pordenone, Italy

    Angelo Stuto M.D. & Prashanty Narisetty M.D.

  3. Chirurgie Proctologique, Besancon, France

    Michel Fantoli M.D.

  4. Ospedale S. Giuseppe, Milano, Italy

    Roberto D. Villani M.D.

  5. Clinique des Cèdres, Cornebarrieu, France

    Michel Queralto M.D.

  6. CHU Purpan, Toulouse, France

    Franck Lazorthes M.D.

  7. Royal Liverpool University Hospital, Liverpool, United Kingdom

    Michael Hershman M.D.

  8. Ospedale “Franchini” di Montecchio Emilia, Montecchio Emilia, Italy

    Alfonso Carriero M.D.

  9. Hôpital Bagatelle, Talence, France

    François Pigot M.D.

  10. Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France

    Richard Villet M.D.

Authors
  1. Paul A. Lehur M.D.
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  2. Angelo Stuto M.D.
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  3. Michel Fantoli M.D.
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  4. Roberto D. Villani M.D.
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  6. Franck Lazorthes M.D.
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  7. Michael Hershman M.D.
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  8. Alfonso Carriero M.D.
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  9. François Pigot M.D.
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  10. Guillaume Meurette M.D.
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  11. Prashanty Narisetty M.D.
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  12. Richard Villet M.D.
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Consortia

for the ODS II Study Group

Corresponding author

Correspondence to Paul A. Lehur M.D..

Additional information

Supported by grants from Ethicon Endo-Surgery (Europe) GmbH, Norderstedt, Germany.

An erratum to this article can be found at http://dx.doi.org/10.1007/s10350-008-9434-x

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Lehur, P.A., Stuto, A., Fantoli, M. et al. 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 (2008). https://doi.org/10.1007/s10350-008-9378-1

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  • DOI: https://doi.org/10.1007/s10350-008-9378-1

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