Abstract
PurposeStapled transanal rectal resection (STARR) in patients with obstructive defecation syndrome (ODS) is limited by the capacity of the circular stapler used. This prospective cohort study was conducted to assess real-world clinical outcomes of STARR with the new CONTOUR® TRANSTAR™ device, shortly named TRANSTAR, at 12 months postoperatively.MethodsFrom January 2009 to January 2011, consecutive patients who underwent TRANSTAR in 22 European colorectal centers were enrolled in the study. Functional outcomes and quality of life were assessed by the changes in a number of scoring systems (Knowles-Eccersley-Scott-Symptom (KESS) score, ODS score, St. Mark’s score, Euro Quality of Life-5 Dimension (EQ-5D) score, and Patient Assessment of Constipation—Quality of Life (PAC-QoL) score), at 12 months as compared to baseline. All complications were recorded and analyzed.ResultsA total of 100 patients (98 % female), mean age 60 years, were entered in the study. Statistically significant improvements were seen in the KESS (median 18 vs. 6; p < 0.01), ODS (median 15 vs. 4; p < 0.01), and PAC-Qol scores (median 2.10 vs. 0.86; p < 0.01). St. Mark’s and EQ-5D scores improved nonsignificantly. Complications were reported in 11 % of patients, including bleeding (5 %), staple line complications (3 %), urinary retention (2 %), and persistent pain (1 %). No major complications or mortality occurred.ConclusionTRANSTAR facilitated a tailored, real circumferential full-thickness rectal resection, leading to improved patient functional and quality of life outcomes at 12 months postoperatively. It represents a safe and effective treatment for ODS in local clinical practice, although the sustainability of real-world results needs to be proven in the long-term follow-up.
Highlights
Obstructive defecation syndrome (ODS) is a poorly understood condition, characterized by the urge to defecate but an impaired ability to evacuate the rectum [1, 2]
As a minimally invasive technique for achieving a fullthickness resection of the distal rectum, stapled transanal rectal resection (STARR) has been proposed for the treatment of ODS by performing two firings of the PPH-01 circular stapler (Ethicon Endo-Surgery, Inc., Cincinnati, OH), which was originally designed for use in stapled hemorrhoidopexy [9, 10]
In 2006, the National Institute for Health and Care Excellence (NICE) in the United Kingdom issued clinical guidance on STARR concluding that the current evidence for its safety and efficacy for ODS did not appear adequate for this procedure to be used without special arrangements for consent and for audit or research [4]
Summary
Obstructive defecation syndrome (ODS) is a poorly understood condition, characterized by the urge to defecate but an impaired ability to evacuate the rectum [1, 2]. The symptoms include frequent visits to the toilet with unsuccessful evacuation attempts, prolonged straining, anorectal discomfort or pain, fresh rectal bleeding, a sensation of incomplete evacuation, and the need for manual assistance [2, 3]. Structural abnormalities such as rectocele, enterocele or genital prolapse, and non-relaxing puborectalis may be associated with ODS, or coexist [4]. The internal rectal mucosal prolapse and rectal intussusception have been recognized as major pathomorphological determinants of ODS, and a plethora of abdominal, vaginal, and laparoscopic surgical procedures have been used to correct the underlying condition [5,6,7,8].
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