title: Correlation between outcome and instrumental findings after stapled transanal rectal resection for obstructed defecation syndrome.
abstract: OBJECTIVE
  Several studies show that stapled transanal rectal resection (STARR) significantly improves constipation in most patients, while others remain symptomatic for obstructed defecation syndrome (ODS). The aim of the study was to analyze clinical, manometric, and endoanal ultrasonography results in order to find any possible correlation between clinical and instrumental data, particularly in dissatisfied patients, both for those who remain symptomatic for ODS and for patients with new-onset fecal disorders.
  
  
  METHODS
  All patients underwent a preoperative and postoperative assessment based on clinical evaluation, proctoscopy, defecography, anorectal manometry, and endoanal ultrasonography. Furthermore, we asked patients about a subjective satisfaction grading of outcome.
  
  
  RESULTS
  From January 2007 to December 2009, 103 patients were treated in our department with STARR for ODS. Postoperative endoanal ultrasound did not demonstrate any variations compared with the preoperative one. Postoperative scores showed statistically significant improvement, with respect to the preoperative value, with good and sufficient scores in 79.6% of patients, and an overall rate of satisfaction of 87.1%. Fecal disorders, including also the slightest alteration of continence, occurred in 24% of patients, in particular soiling 1.8%, urgency 7.4%, occasional gas leakage 5.5%, and liquid/solid leakage 9.3%. Anorectal manometry revealed a statistically significant reduction only in sensitivity threshold and maximum tolerated volume compared to patients with no disorders of continence.
  
  
  CONCLUSIONS
  Results indicate good satisfaction grading and a statistically significant improvement in scores of constipation. There is no close correlation between satisfaction grading and scores. Besides, the assessment of patient's satisfaction often does not match the objective functional outcome.
authors.affiliation: University Hospital of Pisa, Pisa, Italy.
authors.forename: Sonia
authors.initials: S
authors.lastname: Panicucci
authors.affiliation: University Hospital of Pisa, Pisa, Italy University of Siena, Siena, Italy jamjac64@hotmail.com.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Martellucci
authors.affiliation: University Hospital of Pisa, Pisa, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Menconi
authors.affiliation: University Hospital of Pisa, Pisa, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Toniolo
authors.affiliation: University Hospital of Pisa, Pisa, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Naldini
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D015331:Cohort Studies; D003248:Constipation / Q000601:surgery*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012007:Rectum / Q000503:physiopathology / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods*; D016896:Treatment Outcome
keywords: colorectal surgery; evidence-based medicine/surgery; functional results; obstructed defecation syndrome