title: Results, outcome predictors, and complications after stapled transanal rectal resection for obstructed defecation.
abstract: OBJECTIVE
  Obstructed defecation may be treated by stapled transanal rectal resection, but different complications and recurrence rates have been reported. The present study was designed to evaluate stapled transanal rectal resection results, outcome predictive factors, and nature of complications.
  
  
  METHODS
  Clinical and functional data of 123 patients were retrospectively analyzed. All patients had symptoms of obstructed defecation before surgery and had rectocele and/or intussusception. Of them, 85 were operated on by the authors and 38 were referred after stapled transanal rectal resection had been performed elsewhere.
  
  
  RESULTS
  At a median follow-up of 17 (range, 3-44) months, 65 percent of the patients operated on by the authors had subjective improvement. Recurrent rectocele was present in 29 percent and recurrent intussusception was present in 28 percent of patients. At univariate analysis, results were worse in those with preoperative digitation (P<0.01), puborectalis dyssynergia (P<0.05), enterocele (P<0.05), larger size rectocele (P<0.05), lower bowel frequency (P<0.05), and sense of incomplete evacuation (P<0.05). Bleeding was the most common perioperative complication occurring in 12 percent of cases. Reoperations were needed in 16 patients (19 percent): 9 for recurrent disease. In the 38 patients referred after stapled transanal rectal resection, the most common problems were perineal pain (53 percent), constipation with recurrent rectocele and/or intussusception (50 percent), and incontinence (28 percent). Of these patients, 14 (37 percent) underwent reoperations: 7 for recurrence. Three patients presented with a rectovaginal fistula. One other patient died for necrotizing pelvic fasciitis.
  
  
  CONCLUSIONS
  Stapled transanal rectal resection achieved acceptable results at the cost of a high reoperation rate. Patients with puborectalis dyssynergia and lower bowel frequency may do worse because surgery does not address the causes of their constipation. Patients with large rectoceles, enteroceles, digitation, and a sense of incomplete evacuation may have more advanced pelvic floor disease for which stapled transanal rectal resection, which simply removes redundant tissue, may not be adequate. This, together with the complications observed in patients referred after stapled transanal rectal resection, suggests that this procedure should be performed by colorectal surgeons and in carefully selected patients.
authors.affiliation: General Surgery, Clinica Pineta Grande, Via Domiziana Km. 30, Castel Volturno (Caserta) 81030, Italy. gagliarg@yahoo.com
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gagliardi
authors.forename: Mario
authors.initials: M
authors.lastname: Pescatori
authors.forename: Donato F
authors.initials: DF
authors.lastname: Altomare
authors.forename: Gian Andrea
authors.initials: GA
authors.lastname: Binda
authors.forename: Corrado
authors.initials: C
authors.lastname: Bottini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Dodi
authors.forename: Vincenzino
authors.initials: V
authors.lastname: Filingeri
authors.forename: Giovanni
authors.initials: G
authors.lastname: Milito
authors.forename: Marcella
authors.initials: M
authors.lastname: Rinaldi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Romano
authors.forename: Liana
authors.initials: L
authors.lastname: Spazzafumo
authors.forename: Mario
authors.initials: M
authors.lastname: Trompetto
mesh_terms: D000328:Adult; D000368:Aged; D003672:Defecation / Q000502:physiology*; D019841:Defecography; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007443:Intussusception / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012002:Rectal Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013997:Time Factors; D016896:Treatment Outcome