title: Functional outcome and quality of life after stapled transanal rectal resection for obstructed defecation syndrome.
abstract: OBJECTIVE
  Clinical studies have demonstrated that stapled transanal rectal resection with Contour Transtar (Transtar procedure) is a safe and effective treatment for patients with obstructive defecation syndrome. The aim of this study was to determine functional outcome and quality of life after the procedure.
  
  
  METHODS
  Female patients with obstructive defecation syndrome were enrolled prospectively for the Transtar procedure. Intussusception and anterior rectocele were confirmed by clinical investigation and by magnetic resonance defecography. Functional outcome was measured by obstructed defecation syndrome score, severity of symptoms score, and Wexner score preoperatively and postoperatively. Quality of life was assessed by the Cleveland Clinic constipation score, the fecal incontinence quality of life scale, and the SF-36v2 health survey.
  
  
  RESULTS
  Between January 2007 and November 2008, 52 consecutive patients (median age: 64 years) were included in the study. Before the surgery, 12 patients experienced fecal incontinence. Functional scores improved significantly: 6 weeks after surgery, the obstructed defecation syndrome score decreased from a median of 16 (range, 9-22) to 5 (range, 2-10) and the severity of symptoms score, from 16 (range, 9-21) to 4 (range, 0-9) (each P < .0001). After 6 weeks, 10 patients had fecal incontinence and 12 patients experienced fecal urgency. At 3 months, 6 patients were still incontinent, 3 of whom were treated successfully with sacral neuromodulation. Fecal urgency resolved in all cases after 6 months. Quality of life improved, particularly in the mental components.
  
  
  CONCLUSIONS
  Despite the described postoperative symptoms, most of which can be treated conservatively, the Transtar procedure is an effective treatment for patients with obstructive defecation syndrome and improves quality of life significantly.
authors.affiliation: Department of Surgery, Kantonsspital St Gallen, St Gallen, Switzerland.
authors.forename: Katja
authors.initials: K
authors.lastname: Wolff
authors.forename: Lukas
authors.initials: L
authors.lastname: Marti
authors.forename: Ulrich
authors.initials: U
authors.lastname: Beutner
authors.forename: Thomas
authors.initials: T
authors.lastname: Steffen
authors.forename: Jochen
authors.initials: J
authors.lastname: Lange
authors.forename: Franc H
authors.initials: FH
authors.lastname: Hetzer
mesh_terms: D003248:Constipation / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D007443:Intussusception / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D020047:Rectocele / Q000601:surgery*; D012007:Rectum / Q000503:physiopathology / Q000601:surgery*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D017792:Surgical Stapling; D016896:Treatment Outcome