862 Patient Satisfaction and Outcomes Following Stapled Transanal Rectal Resection (STARR) for Obstructed Defecation Syndrome

Abstract

Background: Obstructed defecation syndrome (ODS) is recognized as both a functional (e.g., anismus or anal dyssynergia) and anatomic (e.g., rectocele and internal rectal intussusception) defecatory disorder of the pelvic floor. The purpose of this study was to determine outcomes and patient satisfaction following stapled transanal rectal resection (STARR) for the surgical treatment of ODS. Methods: Between May 2006 and July 2009, 1,580 patients were evaluated for constipation or rectocele-related symptoms. A subset with ODS was assessed with anal physiology studies and defecography. Thirty-seven of these patients were offered STARR procedure for rectocele and internal intussusception and comprise the cohort of this study. Demographic data and surgical complications were tabulated. Long-term outcomes were assessed by comparing preand post-operative subsets of the Wexner constipation scoring system (paired two-tailed Student's t-test) as well as patient satisfaction surveys. Results: A total of 37 patients (100% female) with a mean age of 52.9 years (range: 31-74 years) underwent STARR procedure. All patients had clinically significant rectocele as evidenced on defecography and 82% had concomitant intussusception. Postoperative complications occurred in 13 patients (35.1%) during 90-day follow-up (table). Two of these patients (5.4%) required reintervention: dilation of stricture in one and transanal excision of staple granuloma in another. Long-term follow-up was achieved at a mean of 19.3 months (range: 3-36 months) in 84% of patients. Mean preand post-operative constipation scores were 11.1±3.6 (range: 0-17) and 4.0±3.4 (range: 0-11), respectively (p<1.3x10^-9). Overall outcome was reported as excellent or good in 71% of patients, adequate in 22.5%, and poor in 6.5%. When asked in retrospect if they would undergo the procedure again, 77% responded affirmatively. Of note, 42% of these patients experienced postoperative complications. Conclusions: The STARR procedure for ODS may result in significantly improved patient outcomes and satisfaction. Most complications were minor and did not require reoperative interventions. In appropriately selected patients, the STARR procedure was a beneficial option for the anatomical correction of ODS secondary to rectocele and intussusception.