Stapled transanal rectal resection for symptomatic intussusception: morphological and functional outcome.
BACKGROUND
Stapled transanal rectal resection (STARR) was developed to correct intussusception causing obstructed defecation. Some patients, however, do not profit from this operation as anticipated. We aimed to study the relationship between functional outcome and rectal morphology after STARR.


METHODS
Fifteen consecutive female patients with median age of 64 years [interquartile range (IQR) 58-71 years] were studied before and after STARR. All patients had symptoms of obstructed defecation preoperatively. Pre- and postoperative workup consisted of standardized interview (including Wexner score) with physical examination including procto- and rectoscopy, anorectal manometry, and magnetic resonance (MR) defecography. Median follow up was 18 months (IQR 16-22 months).


RESULTS
STARR was technically successful in all 15 patients without intra- or postoperative complications. Median (IQR) Wexner score of fecal incontinence was 0 (0-0) before and 3 (0-4.5) after surgery (p < 0.05). While all patients had repetitive incomplete defecation preoperatively, this symptom was present in seven patients postoperatively (p < 0.01). Third-degree intussusception was diagnosed during MR defecography in all patients preoperatively. After surgery, no patient had third-degree intussusception but one patient had first-degree and one patient had second-degree intussusception (p < 0.05). Size of rectocele was reduced from 2.9 cm (2.0-3.8 cm) to 0.8 cm (0.6-1.9 cm) (p < 0.05). Sphincter pressures were unchanged during anorectal manometry; however, first sensation during balloon distension in the rectum decreased from 50 ml (40-83 ml) before surgery to 30 ml (25-40 ml) after surgery (p < 0.05).


CONCLUSIONS
Stapled transanal rectal resection (STARR) achieved a high rate of morphological correction of intussusception; however, symptoms of obstructed defecation were not improved to the same extent, which warrants exploration in future studies.
Department of Surgery, Klinikum Grosshadern, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany. Reinhold.Lang@med.uni-muenchen.de
Reinhold A
RA
Lang
Sonja
S
Buhmann
Christine
C
Lautenschlager
Mario H
MH
Müller
Andreas
A
Lienemann
Karl-Walter
KW
Jauch
Martin E
ME
Kreis
D000368:Aged; D003248:Constipation / Q000209:etiology / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007443:Intussusception / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D012002:Rectal Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D017792:Surgical Stapling