Stapled transanal rectal resection for obstructed defecation: a cautionary tale.
OBJECTIVE
This prospective study was designed to assess the efficacy and safety of a novel technique in treating outlet obstruction syndrome using a transanal double-stapling procedure.


METHODS
Two hundred thirty patients (187 female) with obstructed defecation underwent stapled transanal rectal resection over a six-year period with follow-up at 2, 6, and 12 months, then yearly; median follow-up was 24 (range, 12-68) months. All failed conservative measures. Patients with slow transit constipation and puborectalis dyssynergia were excluded.


RESULTS
Operating time was short (median, 35 (range, 20-95) minutes), with 159 (69%) performed as day cases (outpatient). Major complications were seen in 16 (7%); there were no deaths. Twelve (5%) patients reported severe postoperative pain. Immediate postoperative fecal urgency was reported by 107 (46%) patients, but persisted at six months in only 26 (11%). Three (1%) developed recurrent rectal prolapse. Nearly all incontinent patients (98%) reported an improvement, with a median Wexner score reduction of 5 points (P < 0.0001). Constipation improved in 77% of patients. Seventy-seven percent of patients were "very glad" they had the operation, and 86% "recommended" stapled transanal rectal resection to a friend.


CONCLUSIONS
Stapled transanal rectal resection can be performed on a day-case basis with high levels of patient satisfaction. Incontinence and constipation are improved. However, significant morbidity occurs in 7% of patients, and urgency of defecation persists beyond six months in 11%.
Titu
Liviu V
LV
Coloproctology Unit, Frenchay Hospital, North Bristol Hospitals NHS Trust, Bristol, United Kingdom.
Riyad
Kallingal
K
Carter
Helen
H
Dixon
Anthony R
AR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003248:Constipation / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D018709:Statistics, Nonparametric; D017792:Surgical Stapling; D016896:Treatment Outcome