title: Stapled transanal rectal resection with contour transtar for obstructed defecation syndrome:  lessons learned after more than 3 years of single-center activity.
abstract: BACKGROUND
  Obstructed defecation syndrome is a widespread and disabling disease.
  
  
  OBJECTIVE
  We aim to evaluate the safety and efficacy of stapled transanal rectal resection performed with a new dedicated curved device in the treatment of obstructed defecation syndrome.
  
  
  METHODS
  A retrospective review of 187 stapled transanal rectal resections performed from June 2007 to February 2011 was conducted.
  
  
  METHODS
  The entire study was conducted at a university hospital.
  
  
  METHODS
  : All the patients with symptomatic obstructed defecation syndrome and the presence of a rectocele and/or a rectorectal or rectoanal intussusception, in the absence of sphincter contractile deficiency, were included in the treatment protocol.
  
  
  METHODS
  All procedures were performed with the use of the Contour Transtar device. We analyzed the functional results of this technique, the incidence and features of the surgical and functional complications, and ways to prevent or treat them.
  
  
  METHODS
  Constipation was graded by using the Agachan-Wexner constipation score; use of aids to defecate and patient satisfaction were assessed preoperatively and 6 months after surgery. Intraoperative and postoperative complications were also investigated.
  
  
  RESULTS
  The constipation intensity was statistically reduced from the preoperative mean value of 15.8 (± 4.9) to 5.2 (± 3.9) at 6 months after surgery (p < 0.0001). Of the 151 (80.3%) patients who took laxatives and the 49 (26.2%) who used enemas before treatment, only 25 (13.2%; p < 0.0001) and 7 (3.7%; p < 0.0001) continued to do so after surgery. None of the 17 (9.1%) patients who had previously helped themselves with digitations needed to continue this practice. Almost all patients showed a good satisfaction rate (3.87/5) after the procedure.
  
  
  CONCLUSIONS
  Limitations are the short follow-up of 1 year and the design of the study that may introduce potential selection bias.
  
  
  CONCLUSIONS
  The results of this study show that stapled transanal rectal resection performed with the use of the Contour Transtar is a safe and effective procedure to treat obstructed defecation syndrome.
authors.affiliation: Department of Medical-Surgical Sciences and Translational Medicine, St. Andrea Hospital, School of Medicine and Psychology, University Sapienza of Rome, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Masoni
authors.forename: Masoni
authors.initials: M
authors.lastname: Luigi
authors.forename: Francesco Saverio
authors.initials: FS
authors.lastname: Mari
authors.forename: Mari Francesco
authors.initials: MF
authors.lastname: Saverio
authors.forename: Francesco
authors.initials: F
authors.lastname: Favi
authors.forename: Favi
authors.initials: F
authors.lastname: Francesco
authors.forename: Marcello
authors.initials: M
authors.lastname: Gasparrini
authors.forename: Umile Michele
authors.initials: UM
authors.lastname: Cosenza
authors.forename: Cosenza Umile
authors.initials: CU
authors.lastname: Michele
authors.forename: Fioralba
authors.initials: F
authors.lastname: Pindozzi
authors.forename: Pindozzi
authors.initials: P
authors.lastname: Fioralba
authors.forename: Alessandra
authors.initials: A
authors.lastname: Pancaldi
authors.forename: Pancaldi
authors.initials: P
authors.lastname: Alessandra
authors.forename: Antonio
authors.initials: A
authors.lastname: Brescia
authors.forename: Brescia
authors.initials: B
authors.lastname: Antonio
mesh_terms: D001003:Anal Canal / Q000601:surgery; D003248:Constipation / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D003672:Defecation; D019841:Defecography / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005244:Fecal Impaction / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000503:physiopathology*; D020127:Recovery of Function; D020047:Rectocele / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D012007:Rectum / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D013525:Surgical Instruments; D017792:Surgical Stapling / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome