title: The impact of stapled transanal rectal resection on anorectal function in patients with obstructed defecation syndrome.
abstract: OBJECTIVE
  A careful preoperative selection of patients was performed in order to identify those eligible for stapled transanal rectal resection to correct obstructed defecation syndrome. The aim was to assess the consequences of surgery on anorectal function and patient outcomes.
  
  
  METHODS
  From January 2004 to June 2007, 33 female patients (median age, 56.3 years; range, 27-77 years) eligible for stapled transanal rectal resection completed standardized questionnaires for the assessment of constipation (constipation scoring system), quality of life (Patient Assessment of Constipation-Quality of Life Questionnaire), and patient satisfaction (visual analogue scale). A complete clinical reassessment including anorectal manometry and defecography was performed after one year.
  
  
  RESULTS
  At a median follow-up of 18 months, significant improvement in constipation scoring system, quality of life, and visual analog scale (P < 0.0001) was observed. Postoperative defecography confirmed the correction of internal rectal prolapse (P < 0.01) and rectocele (P < 0.0001) with an increase in rectal sensitivity (P < 0.0001). Significant correlations were observed between rectocele correction and rectal sensitivity, as evidenced by a decrease in rectal sensory threshold volumes (P = 0.017; Phi = 0.7), increased rectal sensitivity, and patient's satisfaction index (P = 0.011; Phi = 0.64).
  
  
  CONCLUSIONS
  Stapled transanal rectal resection allowed for the correction of rectocele and intussusceptions. These corrections increased rectal sensitivity, diminished symptoms of obstructed defecation syndrome, and improved the quality of life of patients.
authors.affiliation: U.O. General Surgery, Colo-Rectal Unit, A.O.U. San Martino, Genoa, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Reboa
authors.forename: Marco
authors.initials: M
authors.lastname: Gipponi
authors.forename: Matteo
authors.initials: M
authors.lastname: Ligorio
authors.forename: Matteo
authors.initials: M
authors.lastname: Logorio
authors.forename: Paolo
authors.initials: P
authors.lastname: Marino
authors.forename: Francesca
authors.initials: F
authors.lastname: Lantieri
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery; D015331:Cohort Studies; D003248:Constipation / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003672:Defecation / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D020127:Recovery of Function; D012005:Rectal Prolapse / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D020047:Rectocele / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D017792:Surgical Stapling; D013577:Syndrome; D016896:Treatment Outcome