title: Modified stapled transanal rectal resection (Starr) for full thickness excision of rectal tumour.
abstract: BACKGROUND
  Traditionally, adenomatous rectal lesions and unexpected malignant polyps that could not be removed endoscopically are referred to surgery. Local excision is the treatment of choice, and several techniques have been proposed. The choice of the approach requires that the tumour is excised intact, with a low recurrence rate and limited morbidity. Local excision can be a straight forward or conversely a demanding procedure due to the restricted space in which the surgeon must work and the difficulty of achieving a satisfactory exposure.
  
  
  METHODS
  We describe a modified stapled transanal rectal resection for the excision of flat lesions with a diameter up to 2 cm and located between 5 and 12 cm from the anal verge.
  
  
  CONCLUSIONS
  In our experience, it is quick, simple, and easy to teach but it has not previously been reported. It provides full thickness resection with adequate lateral margins. It overcomes some of the limits of the incomplete surgical field exposure and difficult manipulation, since after the confectioning of double half purse-string suture, the suture and sectioning is made by the stapler device.
authors.affiliation: Department of Surgery, University of Rome, Tor Vergata, Rome, Italy. piersileri@yahoo.com
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Sileri
authors.forename: Vito M
authors.initials: VM
authors.lastname: Stolfi
authors.forename: Giampiero
authors.initials: G
authors.lastname: Palmieri
authors.forename: Domenico
authors.initials: D
authors.lastname: Benavoli
authors.forename: Stefano
authors.initials: S
authors.lastname: D' Ugo
authors.forename: Marco
authors.initials: M
authors.lastname: D' Eletto
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000601:surgery*; D000236:Adenoma / Q000175:diagnosis / Q000601:surgery*; D001706:Biopsy; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy; D003952:Diagnostic Imaging; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D017792:Surgical Stapling