Functional Outcome and Quality of Life After Stapled Transanal Rectal Resection for Obstructed Defecation Syndrome
ABSTRACT Clinical studies have demonstrated that stapled transanal rectal resection with Contour Transtar (Transtar procedure) is a safe and effective treatment for patients with obstructive defecation syndrome. The aim of this study was to determine functional outcome and quality of life after the procedure.
Female patients with obstructive defecation syndrome were enrolled prospectively for the Transtar procedure. Intussusception and anterior rectocele were confirmed by clinical investigation and by magnetic resonance defecography. Functional outcome was measured by obstructed defecation syndrome score, severity of symptoms score, and Wexner score preoperatively and postoperatively. Quality of life was assessed by the Cleveland Clinic constipation score, the fecal incontinence quality of life scale, and the SF-36v2 health survey.
Between January 2007 and November 2008, 52 consecutive patients (median age: 64 years) were included in the study. Before the surgery, 12 patients experienced fecal incontinence. Functional scores improved significantly: 6 weeks after surgery, the obstructed defecation syndrome score decreased from a median of 16 (range, 9-22) to 5 (range, 2-10) and the severity of symptoms score, from 16 (range, 9-21) to 4 (range, 0-9) (each P < .0001). After 6 weeks, 10 patients had fecal incontinence and 12 patients experienced fecal urgency. At 3 months, 6 patients were still incontinent, 3 of whom were treated successfully with sacral neuromodulation. Fecal urgency resolved in all cases after 6 months. Quality of life improved, particularly in the mental components.
Despite the described postoperative symptoms, most of which can be treated conservatively, the Transtar procedure is an effective treatment for patients with obstructive defecation syndrome and improves quality of life significantly.
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ABSTRACT: Background Despite advances in treatment of obstructed defecation syndrome (ODS), no single therapy has been tolerated by all patients. Recently, stapled transanal rectal resection (STARR) has been shown to be a time-saving and relatively easy procedure for treatment of ODS with increasing acceptance by both the patient and surgeon. Our study indeed aimed to evaluate the efficacy and safety of STARR in patients with ODS due to anatomic abnormalities. Methods Fifty consecutive patients with ODS due to symptomatic rectal intussusceptions or rectocele were enrolled in this study. Preoperatively, all patients underwent rectosigmoidoscopy and defecography. All the patients with ODS score ³ 9 and rectal intussusceptions and/or rectocele with failure of at least 6 months medical treatment underwent STARR. Wexner incontinence score, ODS score, and Wexner score for severity of constipation were measured for each patient before and after the surgery. Results Mean ± standard deviation (SD) age of patients was 48.1 ± 1.1 years. Mean ± SD Longo score was 14.7 ± 0.9 before the procedure and 4.3 ± 0.7 after the procedure, which revealed statistically significant difference (p < 0.0001). The mean ± SD Wexner incontinence score was 0.6 ± 0.2 and 1.2 ± 0.3 before and after the STARR, respectively, which did not differ significantly (p = 0.1). However, Wexner constipation score revealed significant improvement after the surgery (13.9 ± 0.6 before the surgery vs. 3.4 ± 0.5 after the surgery; p < 0.0001). Conclusions STARR in patients with ODS due to rectocele or intussusceptions is associated with higher patient’s satisfaction and improvement in constipation, incontinency, and defecation score. STARR may be considered an alternative therapeutic option in ODSs with no desired response to other treatments.European Surgery 02/2013; 45(1). DOI:10.1007/s10353-013-0189-9 · 0.26 Impact Factor
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ABSTRACT: Stapled transanal rectal resection is a novel surgery for obstructed defecation syndrome. Few data on the functional and morphologic outcome after the surgery have been reported. This study aimed to evaluate the functional and morphologic outcome after stapled transanal rectal resection. This is a prospective study of consecutive patients undergoing transanal rectal resection. The study was conducted at a tertiary referral hospital, Beijing, China, from May 2007 to May 2009. Eighty-six consecutive female patients with obstructed defecation syndrome were carefully selected. All patients underwent stapled transanal rectal resection. The main outcome measures were patients' symptoms, obstructed defecation syndrome score, Wexner incontinence score, anorectal manometry and defecography before and 1 year after surgery. The occurrence of all symptoms were significantly reduced after the procedure (P < .0001). Obstructed defecation syndrome score was decreased from 18.17 ± 4.68 preoperatively to 7.36 ± 3.52 postoperatively (P < .0001) with the Wexner incontinence score unchanged. Maximum tolerable rectal volume was significantly decreased (236.08 ± 50.00 vs 205.25 ± 29.60, P < .0001) after surgery with anal sphincter pressures unchanged. Postoperative defecography was performed in 64 patients. Rectocele disappeared in 40 of 62 patients. The depth of rectocele was reduced from 35.40 ± 4.58 mm preoperatively to 19.77 ± 9.19 mm postoperatively (P < .0001). Incomplete evacuation disappeared in 41 of 51 patients. Intussusception was completely corrected in 39 of 56 patients. The reduction of obstructed defection syndrome score was greater in patients with both rectocele and intussusception corrected than others (12.75 ± 2.24 vs 9.17 ± 3.47; P < .0001). This study was limited owing to the lack of a control group and the medium-term results. Stapled transanal rectal resection is an effective procedure for obstructed defecation syndrome. The functional outcome is good with the preservation of sphincter function and continence postoperatively. The morphologic outcome confirmed its efficacy in correcting rectocele and intussusception, and correlated well with clinical improvement.Diseases of the Colon & Rectum 04/2011; 54(4):418-24. DOI:10.1007/DCR.0b013e3182061c81 · 3.20 Impact Factor
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ABSTRACT: Aim: Stapled transanal rectal resection (STARR) is used for patients with Obstructive Defaecation Syndrome (ODS) not responding to conservative management. Reports indicate mixed results and there are no studies publishing the long term outcome. Method: Following full investigation, 37 patients with ODS underwent a STARR procedure by one of the authors (SP) between 2005 and 2010. Results: The median patient age was 53.0 (28-79) years and all were female. Median follow up was 13 (0-57) months, nine patients (24.3%) were followed for longer than 24 months. Eighteen patients had undergone at least one (and often multiple) previous gynaecological procedures including hysterectomy (14), colposuspension (3), vaginal rectocele repair (4) and pelvic floor repair (5). Four patients had had at least one previous rectal operation (stapled anopexy (3), Delorme's procedure (2)). One patient did not attend for post-operative follow up. Of the remaining 36, 18 had resolution of obstructive symptoms. Of the 18 with residual symptoms, 17 eventually reported the same level of symptoms as before the STARR procedure. There was a significant correlation between the presence of residual symptoms and long term ODS recurrence (p<0.0005). For those with residual symptoms, the mean time to symptom recurrence was 3 (95% CI 2.86-11.81) months. Twenty (56%) patients were satisfied with the outcome from the STARR procedure. Conclusion: Residual symptoms are a strong indicator of long term failure. STARR was effective for symptom resolution in 50% of patients. Those who had undergone pelvic floor or rectal prolapse surgery were significantly more likely to experience recurrent symptoms. © 2012 The Authors Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.Colorectal Disease 10/2012; 15(4). DOI:10.1111/codi.12054 · 2.02 Impact Factor