title: Stapled transanal rectal resection for outlet obstruction syndrome: results and follow-up.
abstract: BACKGROUND
  The objective of the present study was to assess safety, effectiveness, and long-term outcomes of stapled transanal rectal resection (STARR) for the cure of outlet obstruction syndrome (OOS).
  
  
  METHODS
  Data were collected over a 3-year period (2004-2007), at the Department of Surgery of the University of Genoa, from 25 consecutive subjects (19 of them females) undergoing STARR because of OOS that had not responded to medical treatment,.
  
  
  RESULTS
  Preoperatively, patients were submitted to clinical examination, defecography, colonoscopy, manometry, and recto-anal reflexes determination. All patients had mucosal prolapse, 15 rectal intussusception, 15 rectocele. Postoperatively no deaths were observed; one patient had a hemorrhage requiring reintervention. Mean time to resumption of normal activity was 8.5 +/- 4.5 days. Patients were followed for a mean of 24.7 +/- 10.9 months (range: 6-42 months). Late specific complications included 3 cases of urge to defecate, 8 of incontinence to flatus. Functional outcome was positive for 22 patients (excellent in 4 cases, good in 15, fairly good in 3). Six months postoperatively (25 s), patients had improvement of the mean Constipation Score (p = 0.0002), less pain during evacuation (p = 0.0003), and reduced use of digital assistance to defecate (p < 0.0001). Continence Grading Scale and enema use remained stable after intervention. Patients had increase in basal sphincter pressure (p = 0.0078) and maximal squeeze pressure (p = 0.0051). Recto-anal reflex study showed increase in abdominal pain threshold (p < 0.0001); anal sphincter relaxation threshold and desire to defecate threshold did not change.
  
  
  CONCLUSIONS
  According to the present study, STARR seemed to be a safe and effective treatment for OOS associated with symptomatic rectocele and intussusception.
authors: Department of Surgery, University of Genoa, Di.C.M.I., Largo Rosanna Benzi 8, Genoa 16132, Italy.
authors: Marco
authors: M
authors: Frascio
authors: Cesare
authors: C
authors: Stabilini
authors: Barbara
authors: B
authors: Ricci
authors: Paolo
authors: P
authors: Marino
authors: Rosario
authors: R
authors: Fornaro
authors: Luigi
authors: L
authors: De Salvo
authors: Francesca
authors: F
authors: Mandolfino
authors: Fabrizio
authors: F
authors: Lazzara
authors: Ezio
authors: E
authors: Gianetta
mesh_terms: D001003:Anal Canal / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007443:Intussusception / Q000150:complications / Q000601:surgery; D008297:Male; D012002:Rectal Diseases / Q000150:complications / Q000601:surgery*; D012005:Rectal Prolapse / Q000601:surgery; D020047:Rectocele / Q000150:complications / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D017792:Surgical Stapling; D016896:Treatment Outcome