title: Stapled trans-anal rectal resection (STARR) by a new dedicated device for the surgical treatment of obstructed defaecation syndrome caused by rectal intussusception and rectocele: early results of a multicenter prospective study.
abstract: OBJECTIVE
  Obstructed defaecation syndrome (ODS) represents a very common clinical problem. The aim of the this prospective multicenter study was to evaluate the efficacy and safety of stapler trans-anal rectal resection (STARR) performed by a new dedicated device, CCS-30 Contour Transtar, in patients with ODS caused by rectal intussusception (RI) and/or rectocele (RE).
  
  
  METHODS
  All the patients who underwent STARR for ODS caused by RI and/or RE at Colorectal Surgery Units of S. Stefano Hospital, Naples, Gepos Hospital, Telese, Benevento and S. Maria della Pietà Hospital, Casoria, Naples, Italy were prospectively introduced into a database. Preoperatively, all the patients underwent anorectal manometry and cinedefecography. The grade of ODS was assessed using a dedicated obstructed defaecation syndrome score (ODS-S). All the patients with a ODS-S >or=12 and RI and/or RE were enrolled. Patients were followed up clinically at 6 months.
  
  
  RESULTS
  Thirty patients, 28 (93.3%) women, mean age 56.6+/-12.7 years, underwent STARR, by Transtar, between February and October 2006. Preoperatively, ODS-S was 15.8+/-2.4. RI was present in 26 (89.6%) and RE (34.4+/-15.2 mm) in 27 (93.1%) patients. No major postoperative complications occurred. The length of hospital stay was 2.5+/-0.6 days. At 6-month follow-up, ODS-S was 5.0+/-2.3 (P<0.001). Successful outcome was achieved in 25 (86.2%) patients.
  
  
  CONCLUSIONS
  STARR, performed by the new dedicated device, CCS-30 Contour Transtar, seems to be an effective and safe procedure to treat ODS caused by RE and/or RI. A longer follow-up and a larger number of patients is needed to confirm these results.
authors.affiliation: Colorectal Surgery Unit, S. Stefano Hospital, Via Michelangelo da Caravaggio, 228, 80126 Naples, Italy. ar@colonproctologia.eu
authors.forename: Adolfo
authors.initials: A
authors.lastname: Renzi
authors.forename: Pasquale
authors.initials: P
authors.lastname: Talento
authors.forename: Cristiano
authors.initials: C
authors.lastname: Giardiello
authors.forename: Giovanni
authors.initials: G
authors.lastname: Angelone
authors.forename: Domenico
authors.initials: D
authors.lastname: Izzo
authors.forename: Giandomenico
authors.initials: G
authors.lastname: Di Sarno
mesh_terms: D000328:Adult; D000368:Aged; D003248:Constipation / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D003672:Defecation / Q000502:physiology*; D019841:Defecography; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007443:Intussusception / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012002:Rectal Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D020047:Rectocele / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012007:Rectum / Q000601:surgery*; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013577:Syndrome; D016896:Treatment Outcome