title: Midterm outcome of stapled transanal rectal resection for obstructed defecation syndrome: a single-institution experience in China.
abstract: OBJECTIVE
  To assess midterm results of stapled transanal rectal resection (STARR) for obstructed defecation syndrome (ODS) and predictive factors for outcome.
  
  
  METHODS
  From May 2007 to May 2009, 75 female patients underwent STARR and were included in the present study. Preoperative and postoperative workup consisted of standardized interview and physical examination including proctoscopy, colonoscopy, anorectal manometry, and defecography. Clinical and functional results were assessed by standardized questionnaires for the assessment of constipation constipation scoring system (CSS), Longo's ODS score, and symptom severity score (SSS), incontinence Wexner incontinence score (WS), quality of life Patient Assessment of Constipation-Quality of Life Questionnaire (PAC-QOL), and patient satisfaction visual analog scale (VAS). Data were collected prospectively at baseline, 12 and 30 mo.
  
  
  RESULTS
  The median follow-up was 30 mo (range, 30-46 mo). Late postoperative complications occurred in 11 (14.7%) patients. Three of these patients required procedure-related reintervention (one diverticulectomy and two excision of staple granuloma). Although the recurrence rate was 10.7%, constipation scores (CSS, ODS score and SSS) significantly improved after STARR (P < 0.0001). Significant reduction in ODS symptoms was matched by an improvement in the PAC-QOL and VAS (P < 0.0001), and the satisfaction index was excellent in 25 (33.3%) patients, good in 23 (30.7%), fairly good in 14 (18.7%), and poor in 13 (17.3%). Nevertheless, the WS increased after STARR (P = 0.0169). Incontinence was present or deteriorated in 8 (10.7%) patients; 6 (8%) of whom were new onsets. Univariate analysis revealed that the occurrence of fecal incontinence (preoperative, postoperative or new-onset incontinence; P = 0.028, 0.000, and 0.007, respectively) was associated with the success of the operation.
  
  
  CONCLUSIONS
  STARR is an acceptable procedure for the surgical correction of ODS. However, its impact on symptomatic recurrence and postoperative incontinence may be problematic.
authors.affiliation: Bin Zhang, Jian-Hua Ding, Yu-Juan Zhao, Shu-Hui Yin, Ying-Ying Feng, Ke Zhao, Department of Colorectal Surgery, the Second Artillery General Hospital, Beijing 100088, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Ding
authors.forename: Yu-Juan
authors.initials: YJ
authors.lastname: Zhao
authors.forename: Meng
authors.initials: M
authors.lastname: Zhang
authors.forename: Shu-Hui
authors.initials: SH
authors.lastname: Yin
authors.forename: Ying-Ying
authors.initials: YY
authors.lastname: Feng
authors.forename: Ke
authors.initials: K
authors.lastname: Zhao
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002681:China; D003248:Constipation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000523:psychology / Q000601:surgery; D003672:Defecation; D005242:Fecal Incontinence / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D012007:Rectum / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D017792:Surgical Stapling; D013997:Time Factors; D016896:Treatment Outcome
keywords: Colorectal surgery; Constipation; Stapled transanal rectal resection