Top

Langenbeck's Archives of Surgery

Published in:

01-02-2006 | Original Article

Stapled transanal rectal resection (STARR): a new option in the treatment of obstructive defecation syndrome

Authors: A. Ommer, K. Albrecht, F. Wenger, M. K. Walz

Published in: Langenbeck's Archives of Surgery | Issue 1/2006

Abstract

Background

Rectocele and distal intussusception are organic causes of outlet obstruction. A new surgical option called the stapled transanal rectal resection (STARR) is described within a prospective study.

Patients and methods

Fourteen patients with symptomatic rectocele (four females), rectocele with coexistent intussusception (eight females), and intussusception (two males) underwent STARR procedure. The symptoms were measured by means of a defecation score (0–20 points).

Results

Complications included local bleeding postoperatively in two cases, and temporary ischuria in four cases. The subjective sense of pain was low; from day 1 postoperatively five patients did not need any analgetics. Only one female patient had prolonged pelvic pain, without any organic reason. All patients showed improvement in rectal evacuation. The mean score of defecation (0–20 points) decreased from 13±3 to 4±3 after 1 month (p<0.05) and remained low. The overall follow-up was 19±9 months. Only one male patient with intussusception had defecation disorder again 6 months after surgery. Three patients had temporary urge incontinence.

Conclusion

STARR is an effective therapy for obstructive defecation disorder due to a symptomatic rectocele and/or a distal intussusception.

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

Ommer A, Köhler A, Athanasiadis S (1998) Funktionsdiagnostik des Anorektums und des Beckenbodens. Dtsch Med Wochenschr 123:537–544PubMedCrossRef

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 38:7–13PubMedCrossRef

Ommer A, Köhler A, Athanasiadis S (1998) Ergebnisse der transperinealen Levatorplastik bei der Behandlung der symptomatischen Rektocele. Chirurg 69:966–972PubMedCrossRef

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 5:149–156.PubMedCrossRef

Athanasiadis S, Heiligers J (1993) Der Wert der abdominalen Rektopexie bei obstruktiven Defäkationsstörungen- Eine prospektive Studie mittels eines Defäkationsindexes, Manometrie und Radiologie. Langenbeck’s Arch Chir 378:92–101

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

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

Araki Y, Ishibashi N, Kishimoto Y, Matono K, Nakagawa M, Nozoe Y, Sasatomi T, Ogata Y, Shirouzu K (2001) Circular stapling procedure for mucosal prolapse of the rectum associated with outlet obstruction. Kurume Med J 48:201–204PubMed

10.

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

11.

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 47:1285–1297PubMedCrossRef

12.

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 37:1133–1141.PubMedCrossRef

13.

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 1499–500PubMedCrossRef

14.

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

15.

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

16.

Karlbom U, Graf W, Nilsson S, Pahlman L (1996) Does surgical repair of a rectocele improve rectal emptying? Dis Colon Rectum 39:1296–1302PubMedCrossRef

17.

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

18.

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

19.

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 41:354–358PubMedCrossRef

20.

Vermeulen J, Lange JF, Sikkenk AC, Harst Evd (2005) Anterolateral rectopexy for correction of rectoceles leads to good anatomical but poor functional results. Tech Coloproctol 9:35–41PubMedCrossRef

21.

Felt-Bersma RJ, Luth WJ, Janssen JJ, Meuwissen SG (1990) Defecography in patients with anorectal disorders. Which findings are clinically relevant? Dis Colon Rectum 33:277–284PubMedCrossRef

22.

Choi JS, Salum MR, Moreira H Jr, Weiss EG, Nogueras JJ, Wexner SD (2000) Physiologic and clinical assessment of patients with rectoanal intussusception. Tech Coloproctol 4:29–33CrossRef

23.

Schwandner O, Poschenrieder F, Gehl HB, Bruch HP (2004) Differenzialdiagnostik der Beckenbodeninsuffizienz. Chirurg 75:850–860PubMedCrossRef

24.

Bartolo DC, Roe AM, Virjee J, Mortensen NJ, Locke-Edmunds JC (1988) An analysis of rectal morphology in obstructed defaecation. Int J Colorectal Dis 3:17–22PubMedCrossRef

25.

McCue JL, Thomson JP (1990) Rectopexy for internal rectal intussusception. Br J Surg 77:632–634PubMedCrossRef

26.

Orrom WJ, Bartolo DC, Miller R, Mortensen NJ, Roe AM (1991) Rectopexy is an ineffective treatment for obstructed defecation. Dis Colon Rectum 34:1–46CrossRef

27.

Christiansen J, Zhu BW, Rasmussen OO, Sorensen M (1992) Internal rectal intussusception: results of surgical repair. Dis Colon Rectum 35:1026–1028; discussion 1028–1029PubMedCrossRef

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 33:573–580PubMedCrossRef

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 42:367–373PubMedCrossRef

30.

Boccasanta P, Venturi M, Salamina G, Cesana BM, Bernasconi F, Roviaro G (2004) 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 19:359–369PubMedCrossRef

Title: Stapled transanal rectal resection (STARR): a new option in the treatment of obstructive defecation syndrome
Authors: A. Ommer
K. Albrecht
F. Wenger
M. K. Walz
Publication date: 01-02-2006
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 1/2006
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-005-0004-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Stapled transanal rectal resection (STARR): a new option in the treatment of obstructive defecation syndrome

Abstract

Background

Patients and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2006

AcSDKP: a new potential marker of malignancy of the thyroid gland

Central perineal hernia mimicking rectocele: a case report

International Symposium: "Modern Technologies in Thyroid Surgery”, 10–11 February 2006, Halle/S., Germany

Functional anatomy of the recurrent and superior laryngeal nerve

Impact of modern technologies on quality of thyroid surgery

A single-institution 25-year review of true parathyroid cysts