title: Comparative outcome of stapled trans-anal rectal resection and macrogol in the treatment of defecation disorders.
abstract: OBJECTIVE
  To prospectively assess the efficacy and safety of stapled trans-anal rectal resection (STARR) compared to standard conservative treatment, and whether preoperative symptoms and findings at defecography and anorectal manometry can predict the outcome of STARR.
  
  
  METHODS
  Thirty patients (Female, 28; age: 51 ± 9 years) with rectocele or rectal intussusception, a defecation disorder, and functional constipation were submitted for STARR. Thirty comparable patients (Female, 30; age 53 ± 13 years), who presented with symptoms of rectocele or rectal intussusception and were treated with macrogol, were assessed. Patients were interviewed with a standardized questionnaire at study enrollment and 38 ± 18 mo after the STARR procedure or during macrogol treatment. A responder was defined as an absence of the Rome III diagnostic criteria for functional constipation. Defecography and rectoanal manometry were performed before and after the STARR procedure in 16 and 12 patients, respectively.
  
  
  RESULTS
  After STARR, 53% of patients were responders; during conservative treatment, 75% were responders. After STARR, 30% of the patients reported the use of laxatives, 17% had intermittent anal pain, 13% had anal leakage, 13% required digital facilitation, 6% experienced defecatory urgency, 6% experienced fecal incontinence, and 6% required re-intervention. During macrogol therapy, 23% of the patients complained of abdominal bloating and 13% of borborygmi, and 3% required digital facilitation. No preoperative symptom, defecographic, or manometric finding predicted the outcome of STARR. Post-operative defecography showed a statistically significant reduction (P < 0.05) of the rectal diameter and rectocele. The post-operative anorectal manometry showed that anal pressure and rectal sensitivity were not significantly modified, and that rectal compliance was reduced (P = 0.01).
  
  
  CONCLUSIONS
  STARR is not better and is less safe than macrogol in the treatment of defecation disorders. It could be considered as an alternative therapy in patients unresponsive to macrogol.
authors.affiliation: Department of Medicine and Medical Specialties, SAPIENZA, Rome University, 00161 Rome, Italy.
authors.forename: Ivano
authors.initials: I
authors.lastname: Biviano
authors.forename: Danilo
authors.initials: D
authors.lastname: Badiali
authors.forename: Laura
authors.initials: L
authors.lastname: Candeloro
authors.forename: Fortunée Irene
authors.initials: FI
authors.lastname: Habib
authors.forename: Massimo
authors.initials: M
authors.lastname: Mongardini
authors.forename: Angelo
authors.initials: A
authors.lastname: Caviglia
authors.forename: Fiorella
authors.initials: F
authors.lastname: Anzini
authors.forename: Enrico S
authors.initials: ES
authors.lastname: Corazziari
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D003248:Constipation / Q000601:surgery; D019841:Defecography; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007443:Intussusception / Q000601:surgery; D008365:Manometry; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011446:Prospective Studies; D012005:Rectal Prolapse / Q000601:surgery; D020047:Rectocele / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D017792:Surgical Stapling / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D011092:Polyethylene Glycols
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