Disappointing long-term outcomes after stapled transanal rectal resection for obstructed defecation.
BACKGROUND
The aim of this study was to assess both short and long-term functional outcomes and the quality of life of patients treated with stapled transanal rectal resection (STARR) for obstructed defecation syndrome (ODS).


METHODS
Forty-six patients with ODS as a result of rectocele and/or rectal intussusceptions were treated with STARR. Data collected included demographics, OR time, pain score using a visual analog scale (VAS), and complications. The study included defecographic assessment and anal manometry [urge-to-defecate volume (UTDV) and maximum tolerable volume (MTV)], both done preoperatively and 1 year postoperatively. A modified obstructed-defecation syndrome questionnaire (MODS), constipation quality of life (PAC-QOL) score, and CCF continence score were all recorded preoperatively and every 6 months during follow-up.


RESULTS
Mean age of the patients was 48.4 years. Forty-five patients had mild postoperative pain (VAS = 1-2). Only one male patient had severe pain (VAS = 7). Three patients developed stenosis at the staple line 6 months after surgery and were dilated manually. Follow-up ranged from 18 to 48 months and the median follow-up was 42 months. The recurrence rate was 6.5% after 18 months, 10.8% after 36 months, and 13% after 42 months. Significant reduction in MTV and UTDV was recorded. MODS and PAC-QOL showed significant improvement after 6 months; this improvement was maintained for 18 months and then there was a rapid decline until the end of the follow-up period.


CONCLUSIONS
STARR is a safe surgical procedure that effectively restores the anatomy and function of the anorectum in patients with ODS. This correction improves functional and QOL scores; however, a high rate of symptomatic recurrence and QOL score decline are expected after 18 months.
Madbouly
Khaled M
KM
Department of Surgery, University of Alexandria, El Raml Station, Alexandria, Egypt. Khaled.Madbouly@alexmed.edu.eg
Abbas
Khaled S
KS
Hussein
Ahmed M
AM
D000328:Adult; D000368:Aged; D003248:Constipation / Q000601:surgery*; D003672:Defecation; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D020127:Recovery of Function; D012007:Rectum / Q000601:surgery*; D017792:Surgical Stapling; D013577:Syndrome; D016896:Treatment Outcome