Initial Experience with Stapled Transanal Rectal Resection under Laparoscopic Surveillance for Rectocele and Rectal Internal Intussusception

Abstract

Purpose. Rectocele and rectal internal intussusception are two organic causes of obstructed defecation syndrome. Asurgical procedure called the stapled transanal rectal resection (STARR), is gaining acceptance as a recommended surgical option to treat these types of obstructed defecation syndrome. We report the initial experience with the stapled transanal rectal resection under laparoscopic surveillance.Patients and Methods. Five patients with symptomatic rectocele and coexistent intussusception underwent STARR procedure combined with laparoscopic surveillance.Results. Post-operative complications included immediate postoperative staple line bleeding in two cases, transient incontinence to flatus in three cases and temporary urge incontinence of flatus in two cases. The postoperative subjective sense of pain was low; all five patients did not need any IM analgesics. In addition, no major complications such as intraabdominal bleeding, rectovaginal fistula or late abscess in the staple line were observed. Postoperatively, all patients experienced better defecation with less straining, less tenesmus and less sensation of incomplete evacuation. No fecal incontinence was detected.Conclusion. STARR procedure under laparoscopic surveillance appears to be a safe and effective therapy for obstructive defecation disorder caused by symptomatic rectocele with internal intussusception. The combination of stapled transanal rectal resection procedure and laparoscopy avoids the threat of intra-abdominal lesions resulting from enterocele or rectovaginal fistula.