863 What Do IBS Symptom Severity Scales Measure? GI Symptoms, Emotions, Cognitions-or Something Else?

Abstract

Chirag B. Patel, Madhu Ragupathi, Nilesh Bhoot, Thomas B. Pickron, Eric M. HaasBackground: Obstructed defecation syndrome (ODS) is recognized as both a functional (e.g.,anismusoranaldyssynergia)andanatomic(e.g.,rectoceleandinternalrectalintussusception)defecatory disorder of the pelvic floor. The purpose of this study was to determine outcomesand patient satisfaction following stapled transanal rectal resection (STARR) for the surgicaltreatmentofODS.Methods:BetweenMay2006andJuly2009,1,580patientswereevaluatedfor constipation or rectocele-related symptoms. A subset with ODS was assessed with analphysiology studies and defecography. Thirty-seven of these patients were offered STARRprocedure for rectocele and internal intussusception and comprise the cohort of this study.Demographic data and surgical complications were tabulated. Long-term outcomes wereassessed by comparing pre- and post-operative subsets of the Wexner constipation scoringsystem (paired two-tailed Student's t-test) as well as patient satisfaction surveys. Results: Atotal 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 evidencedon defecography and 82% had concomitant intussusception. Postoperative complicationsoccurred 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 staplegranuloma in another. Long-term follow-up was achieved at a mean of 19.3 months (range:3-36 months) in 84% of patients. Mean pre- and post-operative constipation scores were11.1±3.6 (range: 0-17) and 4.0±3.4 (range: 0-11), respectively (p<1.3x10^-9). Overall out-come was reported as excellent or good in 71% of patients, adequate in 22.5%, and poorin 6.5%. When asked in retrospect if they would undergo the procedure again, 77%responded affirmatively. Of note, 42% of these patients experienced postoperative complica-tions. Conclusions: The STARR procedure for ODS may result in significantly improvedpatient outcomes and satisfaction. Most complications were minor and did not requirereoperative interventions. In appropriately selected patients, the STARR procedure was abeneficialoptionfortheanatomicalcorrectionofODSsecondarytorectoceleandintussuscep-tion.Surgical complications following STARR during 90-day follow up (note: some patientsexperienced more than one complication).