Patient Satisfaction and Symptomatic Outcomes Following Stapled Transanal Rectal Resection for Obstructed Defecation Syndrome

Abstract

Obstructed defecation syndrome (ODS) is recognized as a functional (e.g., anismus) and anatomic (e.g., rectocele and rectal intussusception) defecatory disorder of the pelvic floor. This study was designed to evaluate outcomes and patient satisfaction following stapled transanal rectal resection (STARR) for the surgical treatment of ODS. Between May 2006 and July 2009, 37 patients underwent STARR for correction of ODS secondary to rectocele and internal intussusception. Demographic data and postoperative outcomes were tabulated. Symptomatic outcomes were assessed by comparing pre- and postoperative subsets of the Wexner constipation scoring system, and quality outcomes were evaluated with patient satisfaction surveys. Thirty-seven female patients with a mean age of 52.9 ± 11.2 y underwent STARR. All patients had clinically significant rectocele as evidenced on defecography and 81.1% had concomitant internal rectal intussusception. Postoperative complications occurred in 13 patients (35.1%). Two of these patients required re-intervention: dilation of stricture and transanal excision of staple granuloma. Mean quality of life follow-up occurred at 20.3 ± 6.5 mo (median: 20 mo, range: 9-36 mo). Mean preoperative and postoperative constipation subset scores were 11.1 ± 3.6 and 4.6 ± 3.9, respectively (P < 0.00001). Overall outcome was reported as "excellent" or "good" in 71.9% of patients, "adequate" in 15.6%, and "poor" in 12.5%. When asked if they would undergo the procedure again, 81.3% responded affirmatively. The STARR procedure results in improved symptomatic outcomes, high patient satisfaction, and an acceptable complication rate. In selected patients, this minimally invasive approach was an acceptable procedure for the surgical correction of ODS secondary to rectocele and intussusception.