Functional Outcome and Quality of Life After Stapled Transanal Rectal Resection for Obstructed Defecation Syndrome

Department of Surgery, Kantonsspital St Gallen, St Gallen, Switzerland.
Diseases of the Colon & Rectum (Impact Factor: 3.75). 06/2010; 53(6):881-8. DOI: 10.1007/DCR.0b013e3181cdb445
Source: PubMed


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.
    No preview · Article · Feb 2013 · European Surgery
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    ABSTRACT: Internal rectal prolapse (rectal intussusception) and rectocele are frequent clinical findings in patients suffering from refractory constipation that may be best characterized as obstructive defecation syndrome. However, there is still no clear evidence whether the stapled transanal rectal resection (STARR) procedure provides a safe and effective surgical option for symptom resolution in patients with obstructive defecation syndrome, as evidence-based guidelines and functional long-term results are still missing. On the basis of the need for objective evaluation, a European group of experts was founded (Stapled Transanal Rectal Resection Pioneers). Derived from 2 meetings (October 26-28, 2006, Gouvieux, France and November 28-29, 2007, St Gallen, Switzerland) a concept for treatment options in patients suffering from obstructive defecation syndrome was developed, including a clear decision-making algorithm specifically focusing on the role of the stapled transanal rectal resection procedure based on clinical symptoms and dynamic imaging and inclusion and exclusion criteria for the stapled transanal rectal resection procedure.
    Full-text · Article · Jul 2008 · Surgical Innovation
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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.
    No preview · Article · Apr 2011 · Diseases of the Colon & Rectum
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