Anatomical and functional results after stapled transanal rectal resection (STARR) for obstructed defaecation syndrome

Abstract

The STARR procedure is a surgical option for the treatment of rectocoele associated with obstructed defaecation syndrome (ODS). The aim of the study was to assess the efficacy of this technique in restoring anatomy and the long-term sustainability of symptom control and quality of life. Of 48 patients operated on from 2003 to 2007, 30 were enrolled for this prospective assessment of anatomical correction and functional improvement of ODS. Results from a standardised questionnaire concerning functional results (ODS score), faecal incontinence (Cleveland Clinic score) and Patient Assessment of Constipation Quality of Life (PAC-QoL) were prospectively collected. Systematic dynamic defaecography, together with anorectal physiology testing, were performed before surgery and 6 months after. 25 patients were available for long-term assessment of functional outcome (more than 4 years). The mean age of the population was 57 +/- 7 years. STARR produced significant improvements in the PAC QoL (p < 0.05) and ODS score (p < .0001), but not in the incontinence score. At defaecography, correction was significant with respect to the depth (p = 0.007), perimeter (p < 0.0001) and neck (p = 0.001) of rectocoele. Anorectal physiology revealed a lower maximal tolerated rectal volume (p<.0001). After 58 months, the 25 patients showed sustained functional results and QoL. Four patients (16%) underwent further surgical procedure for pelvic floor disorders and 8 patients (32%) still required laxatives. Our study confirms the efficacy of the STARR procedure, with sustained improvement in function and QoL. However, a substantial number of patients remain symptomatic.