title: Results in the long-term course after stapled transanal rectal resection (STARR).
abstract: OBJECTIVE
  Stapled transanal rectal resection (STARR) has recently been recommended for patients with obstructed defecation caused by rectocele and rectal wall intussusception. Our study investigates the long-term results and predictive factors for outcome.
  
  
  METHODS
  Between November 2002 and February 2007, 80 patients (69 females) were operated on using the STARR procedure and included in the following study. Symptoms were defined according to the ROME II criteria. Preoperative assessment included clinical examination, colonoscopy, video defecography, and dynamic MRI. Preoperatively and during follow-up visits, we evaluated the Cleveland Constipation Score (CCS) to rate the severity of outlet obstruction and the Wexner Incontinence Score to rate anal incontinence. Patients were asked to judge the outcome of the operation as improved or poor/dissatisfied. We performed a univariate analysis for 11 patient- and disease-related factors to detect an association with outcome.
  
  
  RESULTS
  The median follow-up was 39 months (range 20-78). Major postoperative complications (one staple line insufficiency, one urosepsis, one prolonged urinary dysfunction with indwelling catheter) were found in 3.8%. The result after STARR procedure was a success in the long-term follow-up in 62 patients (77.5%), although the improvement did not persist in 15 patients (18.7%). The mean value of the CCS decreased significantly from 9.3 before surgery to 4.6 after 2 years and increased again slightly to 6.5 after 4-6 years. The Median Wexner Incontinence Score was 3.3 at baseline, but rose significantly to 6.0. However, a third of patients who reported deteriorated continence developed the symptoms 1-4 years after surgery. Of the factors investigated for the prediction of outcome, we could only identify the number of pelvic floor changes in defecography or dynamic MRI as being associated with the success of the operation.
  
  
  CONCLUSIONS
  Our study indicates that STARR is a safe procedure. A significant improvement of symptoms is to be expected, but this improvement may deteriorate with time. Patients' satisfaction is also associated with the occurrence of urge to defecate or incontinence. It remains difficult to predict outcome.
authors.affiliation: Department of General and Visceral Surgery, Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, 01067 Dresden, Germany. Koehlerkat@yahoo.de
authors.forename: Katrin
authors.initials: K
authors.lastname: Köhler
authors.forename: Sigmar
authors.initials: S
authors.lastname: Stelzner
authors.forename: Gunter
authors.initials: G
authors.lastname: Hellmich
authors.forename: Dirk
authors.initials: D
authors.lastname: Lehmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Jackisch
authors.forename: Bernhard
authors.initials: B
authors.lastname: Fankhänel
authors.forename: Helmut
authors.initials: H
authors.lastname: Witzigmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003248:Constipation / Q000150:complications* / Q000175:diagnosis; D003672:Defecation / Q000502:physiology; D019841:Defecography; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011351:Proctoscopy / Q000379:methods*; D020127:Recovery of Function; D012007:Rectum / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013536:Suture Techniques; D013537:Sutures; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult