title: Clinical and morphologic correlation after stapled transanal rectal resection for obstructed defecation syndrome.
abstract: 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.
authors.affiliation: Department of Surgery, Division of Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Dindo
authors.forename: Dominik
authors.initials: D
authors.lastname: Weishaupt
authors.forename: Kuno
authors.initials: K
authors.lastname: Lehmann
authors.forename: Franc H
authors.initials: FH
authors.lastname: Hetzer
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
authors.forename: Dieter
authors.initials: D
authors.lastname: Hahnloser
mesh_terms: 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