title: A transanal procedure using an endoscopic linear stapler for obstructed defecation syndrome: the first Chinese experience.
abstract: BACKGROUND
  Transanal surgery using an endoscopic linear stapler is a recognized, but not widely performed technique for the treatment of obstructed defecation syndrome (ODS). A study of consecutive patients was conducted to evaluate the safety and effectiveness of the technique for the treatment of ODS in Chinese patients.
  
  
  METHODS
  From November 2008 to December 2010, 43 female patients with ODS caused by rectocele and/or rectal intussusception underwent transanal surgery using an endoscopic linear stapler in three Chinese hospitals. Clinical and functional data including the Wexner constipation score and outcome classification were analyzed retrospectively.
  
  
  RESULTS
  The average duration of surgery was 23 ± 4 min (range 15-30 min). Blood loss was 10 ± 2 ml (range 5-15 ml). The average postoperative hospital stay was 5 days (range 4-6 days). The pathologic findings showed that the specimen contained rectal muscle in all patients. Postoperative complications included 4 patients with transient fecal urgency, 3 patients with anorectal pain, and one patient with mild bleeding from the stapled suture line. Three patients reported minor fecal incontinence (Wexner score less than 3). During a median follow-up of 12 months (range, 3-26 months), the mean constipation score improved from preoperative 13.56 to postoperative 5.07 at 1 year (P < 0.05). The outcome at 1 year was excellent in 18 of 43 patients, good in 13, fairly good in 7, and poor in 5. Postoperative defecography was performed in 28 patients. Rectocele disappeared in 15 patients. Rectocele depth was reduced from 34 ± 4 mm preoperatively to 17 ± 3 mm postoperatively (P < 0.05).
  
  
  CONCLUSIONS
  The transanal procedure using an endoscopic linear stapler is an easy, safe, and effective option for selected patients with ODS. Long-term prospective, randomized, controlled studies are needed to confirm the advantages of this procedure in comparison with the traditional transanal and stapled transanal rectal resection (STARR) techniques.
authors: Department of Colorectal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
authors: C
authors: C
authors: Jiang
authors: Z
authors: Z
authors: Ding
authors: M
authors: M
authors: Wang
authors: G
authors: G
authors: Yang
authors: G
authors: G
authors: Situ
authors: Y
authors: Y
authors: Wu
authors: K
authors: K
authors: Zheng
authors: S
authors: S
authors: Tang
authors: Z
authors: Z
authors: Liu
authors: Q
authors: Q
authors: Qian
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002681:China; D003248:Constipation / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003672:Defecation; D019841:Defecography; D005260:Female; D006801:Humans; D007443:Intussusception / Q000150:complications / Q000601:surgery*; D007902:Length of Stay; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D012002:Rectal Diseases / Q000150:complications / Q000601:surgery; D020047:Rectocele / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome