Top

International Journal of Colorectal Disease

Published in:

01-11-2010 | Original Article

Long-term results of stapled transanal rectal resection (STARR) for obstructive defecation syndrome

Authors: Andreas Ommer, Thomas M. Rolfs, Martin K. Walz

Published in: International Journal of Colorectal Disease | Issue 11/2010

Abstract

Background

Rectocele and distal rectal intussusception are organic causes of obstructive defecation syndrome and can be corrected surgically once conservative treatment remedies have been exhausted. Stapled transanal rectal resection (STARR) procedure was introduced as a new treatment approach. This study presents the first long-term results of this procedure.

Patients and procedures

A STARR procedure was performed in 14 patients (two male, 12 female, age 53 ± 12 years) between January 2003 and August 2005. The indication for surgery was a severe, conservatively treated stool evacuation disorder secondary to symptomatic rectocele and/or distal intussusception.

Results

The mean follow-up period was 68 ± 10 (49–83) months. The defecation score (0–20 points) decreased from a preoperative 13.4 ± 3.4 to 3.2 ± 2.0 after 3 months and increased slightly to 4.7 ± 3.4 by the time of the final examination. In 12 patients (85.7%), the obstructive defecation syndrome was significantly improved. These positive results were also maintained in the long-term. Five patients (38.5%) reported a slight worsening of continence in terms of urge incontinence. The most affected patients were those with preoperative normal continence. Procedure-related anal reoperations were required in two patients (14.3%).

Conclusion

Even in long-term, transanal rectal wall resection seems to be an effective therapy for obstructive defecation syndrome. However, it is associated with a substantial number of reoperations and in some patients with persistent urge incontinence.

Ho YH, Tan M, Goh HS (1996) Clinical and physiologic effects of biofeedback in outlet obstruction constipation. Dis Colon Rectum 39:520–524CrossRefPubMed

Ommer A, Kohler A, Athanasiadis S (1998) Diagnosis of the function of the anorectum and pelvic floor. Dtsch Med Wochenschr 123:537–544CrossRefPubMed

Arnold MW, Stewart WR, Aguilar PS (1990) Rectocele repair. Four years’ experience. Dis Colon Rectum 33:684–687CrossRefPubMed

Khubchandani IT, Clancy JP 3rd, Rosen L, Riether RD, Stasik JJ Jr (1997) Endorectal repair of rectocele revisited. Br J Surg 84:89–91CrossRefPubMed

Mellgren A, Anzen B, Nilsson BY, Johansson C, Dolk A, Gillgren P, Bremmer S, Holmstrom B (1995) Results of rectocele repair. A prospective study. Dis Colon Rectum 38:7–13CrossRefPubMed

Ommer A, Kohler A, Athanasiadis S (1998) Results of transperineal levator-plasty in treatment of symptomatic rectocele. Chirurg 69:966–972CrossRefPubMed

Athanasiadis S, Heiligers J (1993) Value of abdominal rectopexy in obstructive disorders of defecation. A prospective study using a defecation index, manometry and radiology. Langenbecks Arch Chir 378:92–101CrossRefPubMed

Boccasanta P, Venturi M, Calabro G, Trompetto M, Ganio E, Tessera G, Bottini C, Pulvirenti D’Urso A, Ayabaca S, Pescatori M (2001) Which surgical approach for rectocele? A multicentric report from Italian coloproctologists. Tech Coloproctol 5:149–156CrossRefPubMed

Gemsenjager E (1996) Internal rectal prolapse: therapy outcome and current status. Schweiz Med Wochenschr 126:1377–1384PubMed

10.

Graf W, Karlbom U, Pahlman L, Nilsson S, Ejerblad S (1996) Functional results after abdominal suture rectopexy for rectal prolapse or intussusception. Eur J Surg 162:905–911PubMed

11.

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; discussion 1212–4PubMed

12.

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

13.

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

14.

Norton C, Chelvanayagam S, Wilson-Barnett J, Redfern S, Kamm MA (2003) Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology 125:1320–1329CrossRefPubMed

15.

Mellgren A, Bremmer S, Johansson C, Dolk A, Uden R, Ahlback SO, Holmstrom B (1994) Defecography. Results of investigations in 2,816 patients. Dis Colon Rectum 37:1133–1141CrossRefPubMed

16.

Thompson JR, Chen AH, Pettit PD, Bridges MD (2002) Incidence of occult rectal prolapse in patients with clinical rectoceles and defecatory dysfunction. Am J Obstet Gynecol 187:1494–1499; discussion 1499–1500CrossRefPubMed

17.

Goh JT, Tjandra JJ, Carey MP (2002) How could management of rectoceles be optimized? ANZ J Surg 72:896–901CrossRefPubMed

18.

Delemarre JB, Kruyt RH, Doornbos J, Buyze-Westerweel M, Trimbos JB, Hermans J, Gooszen HG (1994) Anterior rectocele: assessment with radiographic defecography, dynamic magnetic resonance imaging, and physical examination. Dis Colon Rectum 37:249–259CrossRefPubMed

19.

Segal JL, Karram MM (2002) Evaluation and management of rectoceles. Curr Opin Urol 12:345–352CrossRefPubMed

20.

Watson SJ, Loder PB, Halligan S, Bartram CI, Kamm MA, Phillips RK (1996) Transperineal repair of symptomatic rectocele with Marlex mesh: a clinical, physiological and radiologic assessment of treatment. J Am Coll Surg 183:257–261PubMed

21.

Parker MC, Phillips RK (1993) Repair of rectocoele using Marlex mesh. Ann R Coll Surg Engl 75:193–194PubMed

22.

Pollak J, Davila GW (2003) Rectocele repair: the gynecologic approach. Clin Colon Rectal Surg 16:61–69CrossRef

23.

Ho YH, Ang M, Nyam D, Tan M, Seow-Choen F (1998) Transanal approach to rectocele repair may compromise anal sphincter pressures. Dis Colon Rectum 41:354–358CrossRefPubMed

24.

Planells Roig M, Santafe AS, Miranda de Larra JLG, García Espinosa R, Serralta Serra A (2002) Estudio prospectivo de la perineoplastia con malla de polipropileno en el tratamiento del rectocele sintomático por defecacíon obstructiva. Rev Esp Enferm Dig 94:67–72PubMed

25.

Christiansen J, Zhu BW, Rasmussen OO, Sorensen M (1992) Internal rectal intussusception: results of surgical repair. Dis Colon Rectum 35:1026–1028CrossRefPubMed

26.

Orrom WJ, Bartolo DC, Miller R, Mortensen NJ, Roe AM (1991) Rectopexy is an ineffective treatment for obstructed defecation. Dis Colon Rectum 34:41–46CrossRefPubMed

27.

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

28.

Berman IR, Harris MS, Rabeler MB (1990) Delorme’s transrectal excision for internal rectal prolapse. Patient selection, technique, and three-year follow-up. Dis Colon Rectum 33:573–580CrossRefPubMed

29.

Sielezneff I, Malouf A, Cesari J, Brunet C, Sarles JC, Sastre B (1999) Selection criteria for internal rectal prolapse repair by Delorme’s transrectal excision. Dis Colon Rectum 42:367–373CrossRefPubMed

30.

Pescatori M, Boffi F, Russo A, Zbar AP (2006) Complications and recurrence after excision of rectal internal mucosal prolapse for obstructed defaecation. Int J Colorectal Dis 21:160–165CrossRefPubMed

31.

Harris MA, Ferrara A, Gallagher J, DeJesus S, Williamson P, Larach S (2009) Stapled transanal rectal resection vs. transvaginal rectocele repair for treatment of obstructive defecation syndrome. Dis Colon Rectum 52:592–597PubMed

32.

Isbert C, Reibetanz J, Jayne DG, Kim M, Germer CT, Boenicke L (2009) Comparative study of contour Transtar and STARR procedure for the treatment of obstructed defecation syndrome (ODS)—feasibility, morbidity and early functional results. Colorectal Dis (in press)

33.

Schwandner T, Roblick MH, Hecker A, Brom A, Kierer W, Padberg W, Hirschburger M (2009) Transvaginal rectal repair: a new treatment option for symptomatic rectocele? Int J Colorectal Dis 24:1429–1434CrossRefPubMed

34.

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; discussion 1296–7CrossRefPubMed

35.

Dodi G, Pietroletti R, Milito G, Binda G, Pescatori M (2003) Bleeding, incontinence, pain and constipation after STARR transanal double stapling rectotomy for obstructed defecation. Tech Coloproctol 7:148–153CrossRefPubMed

36.

Schwandner O, Farke S, Bruch HP (2005) Transanale Staplerresektion des distalen Rektums (STARR) bei Defäkationsobstruktion infolge ventraler Rektozele und rektoanaler Intussuszeption. Viszeralchirurgie 40:331–341CrossRef

37.

Sielaff, M, Scherer, R, Gögler, H, Farke, S (2006) Die STARR-Operation—Erfahrungen bei 60 Patienten. Coloproctology 28:217–223CrossRef

38.

Renzi A, Izzo D, Di Sarno G, Izzo G, Di Martino N (2006) Stapled transanal rectal resection to treat obstructed defecation caused by rectal intussusception and rectocele. Int J Colorectal Dis 21:661–667CrossRefPubMed

39.

Pechlivanides G, Tsiaoussis J, Athanasakis E, Zervakis N, Gouvas N, Zacharioudakis G, Xynos E (2007) Stapled transanal rectal resection (STARR) to reverse the anatomic disorders of pelvic floor dyssynergia. World J Surg 31:1329–1335CrossRefPubMed

40.

Gagliardi G, Pescatori M, Altomare DF, Binda GA, Bottini C, Dodi G, Filingeri V, Milito G, Rinaldi M, Romano G, Spazzafumo L, Trompetto M (2008) Results, outcome predictors, and complications after stapled transanal rectal resection for obstructed defecation. Dis Colon Rectum 51:186–195; discussion 195CrossRefPubMed

41.

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 51:1611–1618CrossRefPubMed

42.

Dindo D, Weishaupt D, Lehmann K, Hetzer FH, Clavien PA, Hahnloser D (2008) Clinical and morphologic correlation after stapled transanal rectal resection for obstructed defecation syndrome. Dis Colon Rectum 51:1768–1774CrossRefPubMed

43.

Slim K, Mezoughi S, Launay-Savary MV, Tuech JJ, Michot F, Sielezneff I, Sastre B, Pigot F, Juguet F, Faucheron JL, 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) 145:27–31

44.

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

Title: Long-term results of stapled transanal rectal resection (STARR) for obstructive defecation syndrome
Authors: Andreas Ommer
Thomas M. Rolfs
Martin K. Walz
Publication date: 01-11-2010
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 11/2010
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-010-1042-2

At a glance: The STEP trials

Springer Medicine

Long-term results of stapled transanal rectal resection (STARR) for obstructive defecation syndrome

Abstract

Background

Patients and procedures

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Patients and procedures

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2010

An enhanced recovery programme reduces length of stay after rectal surgery

Should barium enema be the next step following an incomplete colonoscopy?

γ-Catenin is an independent prognostic marker in early stage colorectal cancer

Impact of obesity on surgical and oncological outcomes in the management of colorectal cancer

Chronological changes in the systemic manifestations of intestinal Behcet’s disease and their significance in diagnosis

The comparison of the clinical manifestations and risk factors of colorectal cancer and adenomas: results from a colonoscopy-based study in southern Chinese