Evaluation of the stapled transanal rectal resection technique with two staplers in the treatment of obstructive defecation syndrome.
BACKGROUND
This study was designed to assess the safety and effectiveness of stapled transanal rectal resection (STARR) and to compare the results of two staplers.


METHODS
From February 2001 to June 2005, 37 patients diagnosed with obstructive defecation syndrome were treated with the STARR technique. We analyzed variables related to the patient, diagnosis based on anorectal exploration, surgical technique used, and clinical and radiologic results. We compared these results in patients with procedure prolapsed hemorrhoids (PPH)33-01 (group 1, n = 17) or PPH33-03 (group 2, n = 20). The patients were followed postoperatively at 1, 3, and 6 months, and annually.


RESULTS
Intraoperative hemorrhage at the stapled suture occurred in 13 patients from group 1 and in 6 patients from group 2 (p = 0.03). The degree of postoperative pain was not different between the two groups. During the followup period, radiologic and clinical correction of the rectocele and intussusception was found in 94.6% of the patients, with a recurrence in 1 patient from each group. One patient from group 1 developed stenosis of the anastomosis, which improved with digital dilatations. Six patients from group 1 and none from group 2 (p < 0.05) had granulomas on the staple line at the sites of the reabsorbable reinforcing stitches, which were related to postoperative bleeding and anal discomfort.


CONCLUSIONS
STARR is an effective alternative for treatment of obstructive defecation syndrome, with a low morbidity and a shorter hospital stay. The use of PPH33-03 instead of PPH33-01 decreases the risk of hemorrhagic complications and enables more secure implantation as an outpatient procedure.
Arroyo
Antonio
A
Coloproctology Unit, Department of Surgery, University Hospital of Elche, Alicante, Spain.
Pérez-Vicente
Francisco
F
Serrano
Pilar
P
Sánchez
Ana
A
Miranda
Elena
E
Navarro
José-Manuel
JM
Candela
Fernando
F
Calpena
Rafael
R
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D003672:Defecation / Q000502:physiology; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007443:Intussusception / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D011351:Proctoscopy; D012002:Rectal Diseases / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome