Skip to main content
Top
Published in: International Journal of Colorectal Disease 10/2008

01-10-2008 | Original Article

Stapled trans-anal rectal resection (STARR) by a new dedicated device for the surgical treatment of obstructed defaecation syndrome caused by rectal intussusception and rectocele: early results of a multicenter prospective study

Authors: Adolfo Renzi, Pasquale Talento, Cristiano Giardiello, Giovanni Angelone, Domenico Izzo, Giandomenico Di Sarno

Published in: International Journal of Colorectal Disease | Issue 10/2008

Login to get access

Abstract

Background and aim

Obstructed defaecation syndrome (ODS) represents a very common clinical problem. The aim of the this prospective multicenter study was to evaluate the efficacy and safety of stapler trans-anal rectal resection (STARR) performed by a new dedicated device, CCS-30 Contour Transtar, in patients with ODS caused by rectal intussusception (RI) and/or rectocele (RE).

Materials and methods

All the patients who underwent STARR for ODS caused by RI and/or RE at Colorectal Surgery Units of S. Stefano Hospital, Naples, Gepos Hospital, Telese, Benevento and S. Maria della Pietà Hospital, Casoria, Naples, Italy were prospectively introduced into a database. Preoperatively, all the patients underwent anorectal manometry and cinedefecography. The grade of ODS was assessed using a dedicated obstructed defaecation syndrome score (ODS-S). All the patients with a ODS-S ≥12 and RI and/or RE were enrolled. Patients were followed up clinically at 6 months.

Results

Thirty patients, 28 (93.3%) women, mean age 56.6 ± 12.7 years, underwent STARR, by Transtar, between February and October 2006. Preoperatively, ODS-S was 15.8 ± 2.4. RI was present in 26 (89.6%) and RE (34.4 ± 15.2 mm) in 27 (93.1%) patients. No major postoperative complications occurred. The length of hospital stay was 2.5 ± 0.6 days. At 6-month follow-up, ODS-S was 5.0 ± 2.3 (P < 0.001). Successful outcome was achieved in 25 (86.2%) patients.

Conclusion

STARR, performed by the new dedicated device, CCS-30 Contour Transtar, seems to be an effective and safe procedure to treat ODS caused by RE and/or RI. A longer follow-up and a larger number of patients is needed to confirm these results.
Literature
1.
go back to reference Kamm MA (1997) Constipation. In: Nicholls RJ, Dozois RR (eds) Surgery of the colon & rectum. Churchill Livingstone, New York, pp 657–669 Kamm MA (1997) Constipation. In: Nicholls RJ, Dozois RR (eds) Surgery of the colon & rectum. Churchill Livingstone, New York, pp 657–669
2.
go back to reference Keighley MRB (2000) Stipsi. In: Keighley MRB, Williams NS (eds) Chirurgia di ano-retto e colon. Piccin, Padova, pp 615–644 Keighley MRB (2000) Stipsi. In: Keighley MRB, Williams NS (eds) Chirurgia di ano-retto e colon. Piccin, Padova, pp 615–644
3.
go back to reference 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 21:661–667PubMedCrossRef 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 21:661–667PubMedCrossRef
4.
go back to reference 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 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
5.
go back to reference Boccasanta P, Venturi M, Stuto A, Bottini C, Caviglia A, Carriero A, Mascagni D, Mauri R, Sofo L, Landolfi V (2004) Stapled tansanal rectal resection for outlet obstruct: a prospective, multicenter trial. Dis Colon Rectum 47:1285–1296PubMedCrossRef Boccasanta P, Venturi M, Stuto A, Bottini C, Caviglia A, Carriero A, Mascagni D, Mauri R, Sofo L, Landolfi V (2004) Stapled tansanal rectal resection for outlet obstruct: a prospective, multicenter trial. Dis Colon Rectum 47:1285–1296PubMedCrossRef
6.
go back to reference Arroyo A, Perez-Vicente F, Serrano P, Sanchez A, Miranda E, Navarro JM, Candela F, Calpena R (2007) Evaluation of the stapler transanal rectal resection technique with two staplers in the treatment of obstructive defecation syndrome. J Am Coll Surg 58:743–752 Arroyo A, Perez-Vicente F, Serrano P, Sanchez A, Miranda E, Navarro JM, Candela F, Calpena R (2007) Evaluation of the stapler transanal rectal resection technique with two staplers in the treatment of obstructive defecation syndrome. J Am Coll Surg 58:743–752
7.
go back to reference 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 7:148–153PubMedCrossRef 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 7:148–153PubMedCrossRef
8.
go back to reference Pescatori M, Dodi G, Salafia C, Zbar AP (2005) Rectovaginal fistula after double-stapled transanal rectotomy (STARR) for obstructed defaecation. Int J Colorectal Dis 20:83–85PubMedCrossRef Pescatori M, Dodi G, Salafia C, Zbar AP (2005) Rectovaginal fistula after double-stapled transanal rectotomy (STARR) for obstructed defaecation. Int J Colorectal Dis 20:83–85PubMedCrossRef
9.
go back to reference Renzi A, Brusciano L, Pescatori M, Izzo D, Napoletano V, Rossetti G, del Genio G, del Genio A (2005) Pneumatic balloon dilatation for chronic anal fissure: a prospective, clinical endosonographic, and manometric study. Dis Colon Rectum 48:121–126PubMedCrossRef Renzi A, Brusciano L, Pescatori M, Izzo D, Napoletano V, Rossetti G, del Genio G, del Genio A (2005) Pneumatic balloon dilatation for chronic anal fissure: a prospective, clinical endosonographic, and manometric study. Dis Colon Rectum 48:121–126PubMedCrossRef
10.
go back to reference Hélio M, Wexner SD (1998) Anorectal physiologic testing. In: Beck DE, Wexner SD (eds) Fundamentals of anorectal surgery. Saunders, London, pp 37–53 Hélio M, Wexner SD (1998) Anorectal physiologic testing. In: Beck DE, Wexner SD (eds) Fundamentals of anorectal surgery. Saunders, London, pp 37–53
11.
go back to reference Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD (1996) A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 39:681–685PubMedCrossRef Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD (1996) A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 39:681–685PubMedCrossRef
13.
go back to reference Gosselink MJ, Hop WC, Schouten WR (2001) Rectal compliance in females with obstructed defecation. Dis Colon Rectum 44:971–977PubMedCrossRef Gosselink MJ, Hop WC, Schouten WR (2001) Rectal compliance in females with obstructed defecation. Dis Colon Rectum 44:971–977PubMedCrossRef
14.
go back to reference Schouten WR, Gosselink MJ, Boerma MO, Ginai AZ (1998) Rectal wall contractility in response to an evoked urge to defecate in patients with obstructed defecation. Dis Colon Rectum 41:473–479PubMedCrossRef Schouten WR, Gosselink MJ, Boerma MO, Ginai AZ (1998) Rectal wall contractility in response to an evoked urge to defecate in patients with obstructed defecation. Dis Colon Rectum 41:473–479PubMedCrossRef
15.
go back to reference Bartram CI, Mahieu PH (1985) Radiology of the pelvic floor. In: Henry MM, Swash M (eds) Coloproctology and the pelvic floor. Butterworth, London, pp 151–186 Bartram CI, Mahieu PH (1985) Radiology of the pelvic floor. In: Henry MM, Swash M (eds) Coloproctology and the pelvic floor. Butterworth, London, pp 151–186
16.
go back to reference Kuijpers HC, Bleijenberg G, DeMorre H (1986) The spastic pelvic floor syndrome: large bowel obstruction caused by pelvic floor dysfunction: a radiological study. Int J Colorectal Dis 1:44–48PubMedCrossRef Kuijpers HC, Bleijenberg G, DeMorre H (1986) The spastic pelvic floor syndrome: large bowel obstruction caused by pelvic floor dysfunction: a radiological study. Int J Colorectal Dis 1:44–48PubMedCrossRef
17.
go back to reference Mahiue P, Pringot J, Bodart P (1984) Contribution to the diagnosis of defecation disorders. Gastrointest Radiol 9:253–261CrossRef Mahiue P, Pringot J, Bodart P (1984) Contribution to the diagnosis of defecation disorders. Gastrointest Radiol 9:253–261CrossRef
18.
go back to reference Wexner SD, Jorge JMN (1994) Colorectal physiological test: use or abuse of technology? Eur J Surg 160:167–174PubMed Wexner SD, Jorge JMN (1994) Colorectal physiological test: use or abuse of technology? Eur J Surg 160:167–174PubMed
19.
go back to reference Kaufman HS, Buller JL, Thompson JR, Pannu HK, De Meester SL, Genadry RR, Bluemke DA, Jones B, Rychcik JL, Cundiff GW (2001) Dynamic pelvic magnetic resonance imaging and cystocolpoproctography alter surgical management of pelvic floor disorders. Dis Colon Rectum 11:1575–1583CrossRef Kaufman HS, Buller JL, Thompson JR, Pannu HK, De Meester SL, Genadry RR, Bluemke DA, Jones B, Rychcik JL, Cundiff GW (2001) Dynamic pelvic magnetic resonance imaging and cystocolpoproctography alter surgical management of pelvic floor disorders. Dis Colon Rectum 11:1575–1583CrossRef
20.
go back to reference van Dam JH, Ginai AZ, Gosselink HJ, Huisman WM, Bonyer HJ, Hope WC, Schouten WR (1997) Role of defecography in predicting clinical outcome of rectocele repair. Dis Colon Rectum 40:201–207PubMedCrossRef van Dam JH, Ginai AZ, Gosselink HJ, Huisman WM, Bonyer HJ, Hope WC, Schouten WR (1997) Role of defecography in predicting clinical outcome of rectocele repair. Dis Colon Rectum 40:201–207PubMedCrossRef
21.
go back to reference Jorge JMN, Wexner SD, Ger GC, Salanga VD, Nogueras JJ, Jagelman DG (1993) Cinedefecography and electromyography in the diagnosis of nonrelaxing puborectalis syndrome. Dis Colon Rectum 36:668–676PubMedCrossRef Jorge JMN, Wexner SD, Ger GC, Salanga VD, Nogueras JJ, Jagelman DG (1993) Cinedefecography and electromyography in the diagnosis of nonrelaxing puborectalis syndrome. Dis Colon Rectum 36:668–676PubMedCrossRef
22.
go back to reference Aumann G, Petersen S, Pollack T, Hellmich G, Ludwig K (2004) Severe intra-abdominal bleeding following stapled mucosectomy due to enterocele: report of a case. Tech Coloproctol 8:41–43PubMedCrossRef Aumann G, Petersen S, Pollack T, Hellmich G, Ludwig K (2004) Severe intra-abdominal bleeding following stapled mucosectomy due to enterocele: report of a case. Tech Coloproctol 8:41–43PubMedCrossRef
23.
go back to reference 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 187:1494–1499PubMedCrossRef 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 187:1494–1499PubMedCrossRef
24.
go back to reference Orrom WJ, Bartolo DC, Miller R, Mortensen NJ, Roe AM (1991) Rectopexy in ineffective treatment of obstructed defecation. Dis Colon Rectum 34:41–46PubMedCrossRef Orrom WJ, Bartolo DC, Miller R, Mortensen NJ, Roe AM (1991) Rectopexy in ineffective treatment of obstructed defecation. Dis Colon Rectum 34:41–46PubMedCrossRef
25.
go back to reference Boccasanta P, Rosati R, Venturi M, Cioffi U, De Simone M, Montorsi M, Peracchia A (1999) Surgical treatment of complete rectal prolapse: results of abdominal and perineal procedures. J Laparoendosc Adv Surg Tech 9:235–238CrossRef Boccasanta P, Rosati R, Venturi M, Cioffi U, De Simone M, Montorsi M, Peracchia A (1999) Surgical treatment of complete rectal prolapse: results of abdominal and perineal procedures. J Laparoendosc Adv Surg Tech 9:235–238CrossRef
26.
go back to reference Lieberman H, Hughes C, Dippolito A (2000) Evaluation and outcome of the Delorme procedure in the treatment of rectal outlet obstruction. Dis Colon Rectum 43:188–192CrossRef Lieberman H, Hughes C, Dippolito A (2000) Evaluation and outcome of the Delorme procedure in the treatment of rectal outlet obstruction. Dis Colon Rectum 43:188–192CrossRef
27.
go back to reference Brieger GM, Kordan AR, Houghton CR (1996) Abdoninoperineal repair of pulsion rectocele. J Obstet Gynaecol Res 22:151–156PubMed Brieger GM, Kordan AR, Houghton CR (1996) Abdoninoperineal repair of pulsion rectocele. J Obstet Gynaecol Res 22:151–156PubMed
Metadata
Title
Stapled trans-anal rectal resection (STARR) by a new dedicated device for the surgical treatment of obstructed defaecation syndrome caused by rectal intussusception and rectocele: early results of a multicenter prospective study
Authors
Adolfo Renzi
Pasquale Talento
Cristiano Giardiello
Giovanni Angelone
Domenico Izzo
Giandomenico Di Sarno
Publication date
01-10-2008
Publisher
Springer-Verlag
Published in
International Journal of Colorectal Disease / Issue 10/2008
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-008-0522-0

Other articles of this Issue 10/2008

International Journal of Colorectal Disease 10/2008 Go to the issue