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European Surgery

Erschienen in:

01.02.2013 | Original Scientific Paper

Clinical outcome after stapled transanal rectal resection for obstructed defecation syndrome: the first Iranian experience

verfasst von: R. Azizi, MD, M. Alvandipour, MD, A. Bijari, MD, S. Shoar, MD, M. Alemrajabi, MD

Erschienen in: European Surgery | Ausgabe 1/2013

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Summary

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.

Vorheriger Artikel Importance of ineffective esophageal motility in patients with erosive reflux disease on the long-term outcome of Nissen fundoplication

Nächster Artikel DG-RAR for the treatment of symptomatic grade III and grade IV haemorrhoids: a 12-month multi-centre, prospective observational study

Ding JH, Zhang B, Bi LX, Yin SH, Zhao K. Functional and morphologic outcome after stapled transanal rectal resection for obstructed defecation syndrome. Dis Colon Rectum. 2011;54(4):418–24.PubMedCrossRef

Longo A. Treatment of hemorrhoid disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. Presented at the meeting of the World Congress of Endoscopic Surgery; June 3 to 6; Rome, Italy1998.

Ng K, Ho K, Ooi B, Tang C, Eu K. Experience of 3711 stapled haemorrhoidectomy operations. Br J Surg. 2006;93:226–30.PubMedCrossRef

Andromanakos N, Skandalakis P, Troupis T, Filippou D. Constipation of anorectal outlet obstruction: pathophysiology, evaluation and management. J Gastroenterol Hepatol. 2006;21(4):638–46.PubMedCrossRef

Jayaraman S, Colquhoun PH, Malthaner RA. Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery. Dis Colon Rectum. 2007;50(9):1297–305.PubMedCrossRef

Jayne DG, Schwandner O, Stuto A. Stapled transanal rectal resection for obstructed defecation syndrome: one-year results of the European STARR Registry. Dis Colon Rectum. 2009;52(7):1205–12; discussion 12–4.PubMedCrossRef

Zehler O, Vashist YK, Bogoevski D, Bockhorn M, Yekebas EF, Izbicki JR, et al. Quo vadis STARR? A prospective long-term follow-up of stapled transanal rectal resection for obstructed defecation syndrome. J Gastrointest Surg. 2010;14(9):1349–54.PubMedCrossRef

Felt-Bersma RJ, Tiersma ES, Cuesta MA. Rectal prolapse, rectal intussusception, rectocele, solitary rectal ulcer syndrome, and enterocele. Gastroenterol Clin North Am. 2008;37(3):645–68, ix.PubMedCrossRef

Schwandner O, Stuto A, Jayne D, Lenisa L, Pigot F, Tuech JJ, et al. Decision-making algorithm for the STARR procedure in obstructed defecation syndrome: position statement of the group of STARR Pioneers. Surg Innov. 2008;15(2):105–9.PubMedCrossRef

10.

van Dam JH, Ginai AZ, Gosselink MJ, Huisman WM, Bonjer HJ, Hop WC, et al. Role of defecography in predicting clinical outcome of rectocele repair. Dis Colon Rectum. 1997;40(2):201–7.PubMedCrossRef

11.

Boccasanta P, Venturi M, Stuto A, Bottini C, Caviglia A, Carriero A, et al. Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial. Dis Colon Rectum. 2004;47(8):1285–96; discussion 96–7.PubMedCrossRef

12.

Frascio M, Stabilini C, Ricci B, Marino P, Fornaro R, De Salvo L, et al. Stapled transanal rectal resection for outlet obstruction syndrome: results and follow-up. World J Surg. 2008;32(6):1110–5.PubMedCrossRef

13.

Pechlivanides G, Tsiaoussis J, Athanasakis E, Zervakis N, Gouvas N, Zacharioudakis G, et al. Stapled transanal rectal resection (STARR) to reverse the anatomic disorders of pelvic floor dyssynergia. World J Surg. 2007;31(6):1329–35.PubMedCrossRef

14.

Arroyo A, Perez-Vicente F, Serrano P, Sanchez A, Miranda E, Navarro JM, et al. Evaluation of the stapled transanal rectal resection technique with two staplers in the treatment of obstructive defecation syndrome. J Am Coll Surg. 2007;204(1):56–63.PubMedCrossRef

15.

Arroyo A, Gonzalez-Argente FX, Garcia-Domingo M, Espin-Basany E, De-la-Portilla F, Perez-Vicente F, et al. Prospective multicentre clinical trial of stapled transanal rectal resection for obstructive defaecation syndrome. Br J Surg. 2008;95(12):1521–7.PubMedCrossRef

16.

Titu LV, Riyad K, Carter H, Dixon AR. Stapled transanal rectal resection for obstructed defecation: a cautionary tale. Dis Colon Rectum. 2009;52(10):1716–22.PubMedCrossRef

17.

Hasan HM. Stapled transanal rectal resection for the surgical treatment of obstructed defecation syndrome associated with rectocele and rectal intussusception. ISRN Surg. 2012;2012:652345.PubMed

18.

Zhang B, Ding JH, Yin SH, Zhang M, Zhao K. Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception. World J Gastroenterol. 2010;16(20):2542–8.PubMedCrossRef

19.

Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD. A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum. 1996;39(6):681–5.PubMedCrossRef

20.

Boenicke L, Jayne DG, Kim M, Reibetanz J, Bolte R, Kenn W, et al. What happens in stapled transanal rectum resection? Dis Colon Rectum. 2011;54(5):593–600.PubMedCrossRef

21.

Schwandner T, Hecker A, Hirschburger M, Hecker M, Kierer W, Padberg W. Does the STARR procedure change the pelvic floor: a preoperative and postoperative study with dynamic pelvic floor MRI. Dis Colon Rectum. 2011;54(4):412–7.PubMedCrossRef

22.

Ommer A, Albrecht K, Wenger F, Walz MK. Stapled transanal rectal resection (STARR): a new option in the treatment of obstructive defecation syndrome. Langenbecks Arch Surg. 2006;391(1):32–7.PubMedCrossRef

23.

Pescatori M, Zbar AP. Reinterventions after complicated or failed STARR procedure. Int J Colorectal Dis. 2009;24(1):87–95.PubMedCrossRef

24.

Wolff K, Marti L, Beutner U, Steffen T, Lange J, Hetzer FH. Functional outcome and quality of life after stapled transanal rectal resection for obstructed defecation syndrome. Dis Colon Rectum. 2010 Jun;53(6):881–8.

25.

Mellgren A, Bremmer S, Johansson C, Dolk A, Uden R, Ahlback SO, et al. Defecography. Results of investigations in 2,816 patients. Dis Colon Rectum. 1994;37(11):1133–41.PubMedCrossRef

Titel: Clinical outcome after stapled transanal rectal resection for obstructed defecation syndrome: the first Iranian experience
verfasst von: R. Azizi, MD
M. Alvandipour, MD
A. Bijari, MD
S. Shoar, MD
M. Alemrajabi, MD
Publikationsdatum: 01.02.2013
Verlag: Springer Vienna
Erschienen in: European Surgery / Ausgabe 1/2013
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI: https://doi.org/10.1007/s10353-013-0189-9

Springer Medizin Österreich

Summary

Background

Methods

Results

Conclusions

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