Indications, technique and results of the STARR procedure

Abstract

Rectal intussusception and ventral rectocele are frequent morphological findings in patients suffering from obstructed defecation syndrome (ODS). After failed conservative treatment asurgical option can be discussed. Surgical approaches include the stapled transanal rectal resection (STARR) procedure, which is performed as atransanal approach by using two circular (PPH01) staplers for ventral and dorsal full-thickness resection of the distal rectum. Both retrospective and prospective studies as well as data from the German STARR registry demonstrated that the STARR procedure is safe and effective for symptom improvement and resolution in ODS associated with rectal intussusception in the short-term; however, disappointing functional results, particularly related to fecal incontinence and urgency, severe complications and high rates of revision surgery have also been documented. In general, based on the diagnostic and therapeutic challenges in ODS related to rectal intussusception, patient selection for STARR seems to be the key for success; therefore, this review summarizes and evaluates the indications, surgical technique, results, controversies and current trends of the "conventional" STARR procedure using two circular (PPH01) staplers.