Stapled Transanal Rectal Resection for the Surgical Treatment of Obstructed Defecation Syndrome Associated with Rectocele and Rectal Intussusception

Hesham M Hasan,Hani M Hasan

doi:10.5402/2012/652345

Hesham M Hasan, Hani M Hasan

Open Access

https://doi.org/10.5402/2012/652345

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Journal: ISRN Surgery	Publication Date: Mar 25, 2012
Citations: 49	License type: CC BY 3.0

Affiliation: Ain Shams University, Al Azhar University

Abstract

Obstructed defecation syndrome (ODS) is one of the most widespread clinical problems which frequently affects middle-aged females. There is a new surgical technique called stapled transanal rectal resection (STARR) that makes it possible to remove the anorectal mucosa circumferential and reinforce the anterior anorectal junction wall with the use of a circular stapler. This surgical technique developed by Antonio Longo was proposed as an effective alternative for the treatment of ODS. In this study we present our preliminary results with the STARR operation for the treatment of ODS. For this purpose, 40 consecutive female patients with ODS due to rectal intussusception (RI) and/or rectocele (RE) were recruited in this prospective clinical study, from May 2008 to October 2010. No major operative or postoperative complications were recorded, and after 12-month follow-up, significant improvement in the ODS score system was observed, and the symptoms of constipation improved in 90% of patients; 20% of patients judged their final clinical outcome as excellent, 55% as good, and 15% as moderate, with only 10% having poor results. After analyzing our results we can conclude that STARR is an effective and safe procedure for the treatment of obstructed defecation syndrome due to rectal intussusception and/or rectocele and can be performed safely without major morbidity.

Highlights

Obstructed defecation syndrome (ODS) is a frequently occurring condition that usually affects middle-aged females
By using anal 3-dimensional ultrasonography (3-DAUS), Regadas et al [3] demonstrated that the anal canal is asymmetrical and that the internal anal sphincter is shorter in women, it is formed distally in the anterior upper anal canal weakening the anorectal junction that is devoid of striated muscle or any other anatomic support structure [4]
In this study we present our preliminary results with the stapled transanal rectal resection (STARR) operation for the treatment of obstructive defecation syndrome due to rectal intussusception (RI) and RE

Summary

Introduction

Obstructed defecation syndrome (ODS) is a frequently occurring condition that usually affects middle-aged females. This disease can affect the quality of life of many patients as these patients are obliged to spend several hours a day in the toilet; other symptoms of this disease include feeling of incomplete evacuation, excessive straining during defecation, the need for digital vaginal or perineal assistance, and the use of enemas or suppositories to defecate [1]. By using anal 3-dimensional ultrasonography (3-DAUS), Regadas et al [3] demonstrated that the anal canal is asymmetrical and that the internal anal sphincter is shorter in women, it is formed distally in the anterior upper anal canal weakening the anorectal junction that is devoid of striated muscle or any other anatomic support structure [4].

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