title: Enterocele is not a contraindication to stapled transanal surgery for outlet obstruction: an analysis of 170 patients.
abstract: OBJECTIVE
  Enterocele is common among patients suffering from obstructive defecation syndrome (ODS), but it is often considered a contraindication for stapled transanal surgery. The functional results and complication rates were compared in patients with or without enterocele who were treated with stapled transanal rectal resection (STARR) for ODS.
  
  
  METHODS
  Patients presenting with ODS were evaluated using standardized clinical and radiological investigations. A total of 170 patients were treated with either PPH01-STARR or Contour Transtar® and were followed up for a median of 18 months.
  
  
  RESULTS
  On preoperative defecography, 55 (32%) of 170 patients were found to have an enterocele. The preoperative Cleveland Clinic Constipation Scores (CCCS) in patients with and without enterocele were (mean ± standard deviation) 15.9 ± 5.4 and 15.4 ± 5.2, respectively. At 18 months postoperatively the CCCS were 8.5 ± 2.7 and 8.1 ± 2.6 (P < 0.001), respectively, in patients with and without enterocele. Morbidity was 7.3% (n = 4) in patients with enterocele (anal pain, n = 1; minor bleeding, n = 2; and acute urinary retention, n = 1) and 7.0% (n = 8) in patients without enterocele (anal pain, n = 3; minor bleeding, n = 3; acute urinary retention, n = 1; and staple line dehiscence, n = 1). There were no cases of pelvic sepsis, small bowel injury or postoperative ileus. No patient needed surgical re-operation.
  
  
  CONCLUSIONS
  There was no difference in functional outcome and postoperative complications in patients with and without enterocele undergoing STARR for ODS.
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Wuerzburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Reibetanz
authors.forename: L
authors.initials: L
authors.lastname: Boenicke
authors.forename: M
authors.initials: M
authors.lastname: Kim
authors.forename: C T
authors.initials: CT
authors.lastname: Germer
authors.forename: C
authors.initials: C
authors.lastname: Isbert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D003248:Constipation; D003672:Defecation / Q000502:physiology*; D019841:Defecography; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006547:Hernia / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D012007:Rectum / Q000601:surgery*; D017792:Surgical Stapling / Q000009:adverse effects; D013577:Syndrome