Clinical and morphologic correlation after stapled transanal rectal resection for obstructed defecation syndrome.
OBJECTIVE
The clinical and morphologic outcome of patients with obstructed defecation syndrome after stapled transanal rectal resection was prospectively evaluated.


METHODS
Twenty-four consecutive patients (22 women; median age, 61 (range, 36-74) years) who suffered from obstructed defecation syndrome and with rectal redundancy on magnetic resonance defecography were enrolled in the study. Constipation was assessed by using the Cleveland Constipation Score. Morphologic changes were determined by using closed-configuration magnetic resonance defecography before and after stapled transanal rectal resection.


RESULTS
After a median follow-up of 18 (range, 6-36) months, Cleveland Constipation Score significantly decreased from 11 (range, 1-23) preoperatively to 5 (range, 1-15) postoperatively (P = 0.02). In 15 of 20 patients, preexisting intussusception was no longer visible in the magnetic resonance defecography. Anterior rectoceles were significantly reduced in depth, from 30 mm to 23 mm (P = 0.01), whereas the number of detectable rectoceles did not significantly change. Complications occurred in 6 of the 24 patients; however, only two were severe (1 bleeding and 1 persisting pain requiring reintervention).


CONCLUSIONS
Clinical improvement of obstructed defecation syndrome after stapled transanal rectal resection correlates well with morphologic correction of the rectal redundancy, whereas correction of intussusception seems to be of particular importance in patients with obstructed defecation syndrome.
Dindo
Daniel
D
Department of Surgery, Division of Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland.
Weishaupt
Dominik
D
Lehmann
Kuno
K
Hetzer
Franc H
FH
Clavien
Pierre-Alain
PA
Hahnloser
Dieter
D
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D003672:Defecation; D019841:Defecography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012002:Rectal Diseases / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D017792:Surgical Stapling; D013577:Syndrome; D016896:Treatment Outcome