Short-term outcomes after anterior stapling rectotomy using a single stapler device for rectocele

Abstract

Abstract Background Stapled transanal rectal segmental resection (STARR) is a technique for treatment of obstructive defecation syndrome (ODS) when associated with rectocele and/or intussusceptions. Objectives To evaluate a simplified method using a single stapler device for isolated anterior rectal wall correction of structural abnormalities (single-STARR technique). Materials and methods Patients who were diagnosed with ODS underwent the single-STARR procedure. Their baseline symptoms were measured by using a modified obstructed defecation syndrome (MODS) questionnaire score. Evacuation proctography was performed to exclude functional anorectal disorders. Colonoscopy was selectively performed and for all patients older than 50 years. Single-STARR procedure was performed in cases where there was no evidence of an inflammatory, metabolic, neoplastic process, or functional disorders. The summed global score of ODS ranged from 0 (normal) to 24 (severe). Outcomes were determined by evaluating the postoperative improvement using a MODS score. Results A total of 9 patients (mean (SD) age 53 (13.6) years) with ODS were eligible for the study. Both rectocele and intussusceptions were diagnosed from preoperative defecography in 7 of the patients. Single-STARR was successfully performed without intraoperative complications in all patients with a mean operative time of 52 (12.7) min. The mean severity of symptoms decreased significantly at the 3rd and 6th (P < 0.01) month after surgery. However, one-third of patients experienced persistence of symptoms or symptom score deterioration on the 12th month after surgery. Conclusion The single-STARR procedure provided short-term symptom relief with no serious postoperative complication in a small series of 9 cases.