title: Quo vadis STARR? A prospective long-term follow-up of stapled transanal rectal resection for obstructed defecation syndrome.
abstract: BACKGROUND
  Functional and clinical long-term outcome after stapled transanal rectal resection (STARR) in patients with an isolated symptomatic rectocele are investigated. Short-term results after 1 year are comparable with the functional outcome even after 5 years. Eighty per cent of the patients were still satisfied. STARR is an alternative procedure to the conventional surgical approaches for patients with an obstructed defecation syndrome and rectocele. Several studies have reported short-term outcome after STARR, but long-term results are still missing. The objective of this study was to evaluate long-term clinical outcome after STARR with a follow-up of 5 years.
  
  
  METHODS
  Twenty patients with only an isolated symptomatic rectocele due to obstructed defecation syndrome were subjected to STARR. Functional and clinical outcome was assessed by Outlet Obstruction Syndrome score (OOS score), Wexner score (WS), and Symptom Severity score (SSS score). Data were prospectively collected over 7 years.
  
  
  RESULTS
  The perioperative morbidity after STARR accounted for 20% (n = 4). One patient was subjected to reoperation due to perforation, two postoperative bleedings occurred, and one patient developed an increasing local granulomatous reaction at the stapler line. The median follow-up accounted for 66 months (range 60-84). Sixteen patients (80%) were satisfied with the functional outcome. The median OOS, SSS and WS score improved significantly already after 1 year in these patients and remained stable at 5-year follow-up. In contrast, four patients were classified as treatment failures since the OOS score and the SSS score showed no improvement. At 5-year follow-up, these patients remained symptomatic without improvement in OOS and SSS scores.
  
  
  CONCLUSIONS
  The STARR procedure is an effective operation in isolated symptomatic rectoceles with regard to relief of the obstructed defecation syndrome. The short-term improvement after STARR predicts long-term outcome in obstructed defecation syndrome caused by a rectocele.
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Zehler
authors.forename: Yogesh K
authors.initials: YK
authors.lastname: Vashist
authors.forename: Dean
authors.initials: D
authors.lastname: Bogoevski
authors.forename: Maximillian
authors.initials: M
authors.lastname: Bockhorn
authors.forename: Emre F
authors.initials: EF
authors.lastname: Yekebas
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Izbicki
authors.forename: Asad
authors.initials: A
authors.lastname: Kutup
mesh_terms: D000368:Aged; D003248:Constipation / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003672:Defecation / Q000502:physiology*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020047:Rectocele / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D017792:Surgical Stapling; D013536:Suture Techniques / Q000295:instrumentation*; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome