Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception

AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with rectocele and/or rectal intussusception underwent STARR.The preoperative status,perioperative and postoperative complications at baseline,3,6 and 12-mo were assessed.Data were collected prospectively from standardized questionnaires for the assessment of constipation[constipation scoring system,Longo’s obstructed defecation syndrome(ODS)score system,symptom severity score],patient satisfaction (visual analogue scale),and quality of life(Patient Assessment of Constipation-Quality of Life Questionnaire).RESULTS:At a 12-mo follow-up,significant improvement in the constipation scoring system,ODS score system,symptom severity score,visual analog scale and quality of life(P<0.0001)was observed.The symptoms of constipation improved in 90%of patients at 12 mo after surgery.The self-reported definitive outcome was excellent in 15(30%)patients,fairly good in 8(16%),good in 22(44%),and poor in 5(10%).CONCLUSION:STARR can be performed safely without major morbidity.Moreover,the procedure seems to be effective for patients with obstructed defecation associated with symptomatic rectocele and rectal intussusception.

Outcomes of a modified Bresler procedure for the treatment of rectocele with rectal intussusception

Background:Obstructed defecation syndrome(ODS)is a condition that is frequently caused by rectocele and rectal intussusception.This study aimed to evaluate the effectiveness of a modified Bresler procedure for the treatment of ODS.The outcomes of this modified procedure were compared with the stapled transanal rectal resection(STARR)procedure.Methods:We performed a retrospective analysis of the clinical data from 76 female patients who presented with ODS between June 2014 and June 2016.The patients were divided into two treatment groups,namely Modified and STARR.Patients in the Modified group(n=36)underwent the modified Bresler procedure,which involved posterior rectal-wall resection using a circular tubular stapler with multilevel purse-string sutures.Patients in the STARR group(n=40)underwent the standard STARR procedure.We analysed post-operative complications,Wexner constipation scores(WCS),rectocele depths,and four-point post-operative satisfaction scales.Results:Patients in the Modified group exhibited shorter operative times and fewer post-operative complications(both P<0.05).At 12 months post-operatively,both the Modified and STARR groups displayed a significant improvement in the Wexner constipation score and the depth of rectocele.The post-operative WCS for the Modified group were significantly improved compared to those for the STARR group(P<0.05),while there was no significant difference in the rectocele depth between the two groups(P>0.05).Post-operative interviews at post-operative 12 months showed that patients in the Modified group had a better satisfaction(P=0.05).Conclusions:Our modified procedure may be an effective treatment strategy for patients experiencing ODS caused by rectocele and rectal intussusception,with fewer complications and effective relief of symptoms.

Comparative outcome of stapled trans-anal rectal resection and macrogol in the treatment of defecation disorders

AIM:To prospectively assess the eff icacy and safety of stapled trans-anal rectal resection(STARR) compared to standard conservative treatment,and whether preoperative symptoms and findings at defecography and anorectal manometry can predict the outcome of STARR.METHODS:Thirty patients(Female,28;age:51 ± 9 years) with rectocele or rectal intussusception,a defecation disorder,and functional constipation were submitted for STARR.Thirty comparable patients(Female,30;age 53 ± 13 years),who presented with symptoms of rectocele or rectal intussusception and were treated with macrogol,were assessed.Patients were interviewed with a standardized questionnaire at study enrollment and 38 ± 18 mo after the STARR procedure or during macrogol treatment.A responder was def ined as an absence of the Rome Ⅲ diagnostic criteria for functional constipation.Defecography and rectoanal manometry were performed before and after the STARR procedure in 16 and 12 patients,respectively.RESULTS:After STARR,53% of patients were responders;during conservative treatment,75% were responders.After STARR,30% of the patients reported the use of laxatives,17% had intermittent anal pain,13% had anal leakage,13% required digital facilitation,6% experienced defecatory urgency,6% experienced fecal incontinence,and 6% required re-intervention.During macrogol therapy,23% of the patients complained of abdominal bloating and 13% of borborygmi,and 3% required digital facilitation.No preoperative symptom,defecographic,or manometric finding predicted the outcome of STARR.Post-operative defecography showed a statistically significant reduction(P < 0.05) of the rectal diameter and rectocele.The postoperative anorectal manometry showed that anal pressure and rectal sensitivity were not significantly modified,and that rectal compliance was reduced(P = 0.01).CONCLUSION:STARR is not better and is less safe than macrogol in the treatment of defecation disorders.It could be considered as an alternative therapy in patients unresponsive to macrogol.