STARR surgery in the treatment of rectocele and rectal intussusception


Authors: J. Örhalmi 1;  K. Klos 2;  A. Ferko 1;  S. Jackanin 2
Authors‘ workplace: Chirurgická klinika Lékařské fakulty UK v Hradci Králové a Fakultní nemocnice Hradec Králové přednosta: Prof. MUDr. A. Ferko, CSc. 1;  Vítkovická Nemocnice, a. s., Centrum péče o zažívací trakt, Chirurgické oddělení primář: Doc. MUDr. P. Holéczy, CSc. 2
Published in: Rozhl. Chir., 2012, roč. 91, č. 12, s. 649-653.
Category: Review

Podpořeno projektem (Ministerstva zdravotnictví) koncepčního rozvoje výzkumné organizace 00179906

Overview

Introduction:
Rectocele and intussusceptions are amongst the most frequent causes of Obstructed Defecation Syndrome (ODS). ODS diagnostics has been constantly improving which results in more precise indication criteria for individual surgical approaches. The work discusses indications for Stapled TransAnal Rectal Resection (STARR) as well as the results of the seven-year follow-up.

Material and methods:
Female patients with ODS score over 7 were indicated for STARR procedure after all conservative treatment possibilities failed. The proper indication requires that other causes of ODS be excluded. The retrospective analysis of prospectively collected data was employed.

Results:
Between January 2005 and October 2012 29 STARR procedures for rectocele were performed. Morbidity rate of the set of our patients was 6.9%. None of the patients died. We recorded bleeding from the staple line in seven patients (without surgical revision), and urinary infection in two patients. Bleeding from staple line was present in seven causes and urinary infection was present twice.

Conclusion:
The STARR procedure seems to be an effective and safe treatment for ODS associated with rectocele and intussusception. The overall morbidity rate is low. Further investigation is required to optimize patientęs selection and to reduce the potential complications and failure during postoperative period.

Key words:
STARR – rectocele – Obstructed Defecation Syndrome - constipation


Sources

1. Wadhawan H, Shorthouse AJ, Brown SR. Surgery for obstructed defecation:does the use of the Contour device ( Trans-STARR) improve results? Colorectal Dis 2010;9:885–890.

2. Ding JH, Zhang B, Bi L. Functional and Morphologic Outcome After Stapled Transanal Rectal Resection for Obstructed Defecation Syndrome. Dis Colon Rectum 2011;4:418–424.

3. van Dam JH, Hop WCJ, Schouten WR. Analysis of Patients with Poor Outcome of Rectocele Repair. Dis.Colon Rectum 2000;11:1556–1560.

4. Pescatori M, Spyrou M, Pulvirenti d’Urso A. A prospective evaluation of occult disorders in obstructed Defecation using the‘icebergdiagram. Colorectal Dis 2006;8:785–789.

5. Jayne DG, Schwandner O, Stuto A. Stapled Transanal Rectal Resection for Obstructed Defecation Syndrome: One-Year Results of the European STARR Registry, Dis Colon Rectum 2009;7: 1205–1214.

6. Thornton MJ, Lam A, King DW. Laparoscopic or Transanal Repair of Rectocele? A Retrospective Matched Cohort Study. Dis Colon Rectum 2005;4:792–798.

7. Lamah M, Hoand J, Leicester RJ. Results of anterior levatorplasty for rectocele. Colorectal Dis 2001;3:412–416.

8. Oom DMJ, Gosselink P, vanWijk JJ, vanDijland VRM, Schouten WR. Rectocele repair by anterolateral rectopexy:long-term functional outcome. Colorectal Dis 2008;10:925–930.

9. Bruch HP, Herold A, Schiedeck T, Schwandner O. Laparoscopic surgery for rectal prolapse and outlet obstruction. Dis Colon Rectum 1999;9:1189–1194.

10. Gagliardi G, Pescatori M, Altomare D, Binda GA. Results,Outcome Predictors, and Complications after Stapled Transanal Rectal Resection for Obstructed Defecation. Dis Colon Rectum 2008;2:186–195.

11. Block IR. Transrectal repair of rectocele using obliterative suture. Dis Colon Rectum 1986;29:707–11.

12. Arnold W, Stewart WR, Aguilar PS. Rectocele repair: four years’ experience. Dis Colon Rectum 1990;33:684–7.

13. Janssen LW, van Dijke CF. Selection criteria for anterior rectal wall repair in symptomatic rectocele and anterior rectal wall prolapse. Dis Colon Rectum 1994;37:1100–7.

14. Boccasanta P, Venturi M, Calabrė G, Trompetto M, Ganio E, Tessera G, Bottini C, Pulvirenti d’Urso A, Ayabaca S, Pescatori M. Which surgical approach for rectocele? A multicentric report from Italian coloproctologists. Tech Coloproctol 2001;5:149–156.

15. Sarles JC, Arnaud A, Selezneff I, Olivier S. Endo-rectal repair of rectocele. Int J Colorectal Dis 1989;3:167–171.

16. Schwandner T, Hecker A, Hirschburger M, Hecker M, Kierer W, Padberg W. Does the STARR Procedure Change the Pelvic Floor: A Preoperative and Postoperative Study With Dynamic Pelvic Floor MRI. Dis Colon Rectum 2011;4:412–417.

17. Goede AC, Glancy D, Carter H, Mills A, Mabey K, Dixon AR. Medium-term results of stapled transanal rectal resection (STARR) for obstructed defecation and symptomatic rectal-anal intussusception. Colorectal Dis 2011;9:1052–1057.

18. Boccasanta P, Venturi M, Stuto A. Stapled Transanal Rectal Resection for Outlet Obstruction: A Prospective, Multicenter Trial Dis Colon Rectum 2004;8:1285–1297.

19. Köhler K, Stelzner S, Hellmich G. Results in the long-term course after stapled transanal rectal resection (STARR). Langenbecks Arch Surg 2012;3:771–778.

20. Reboa G, Gipponi M, Logorio M. The Impact of Stapled Transanal Rectal Resection On Anorectal Function in Patients with Obstructed Defecation Syndrome. Dis Colon Rectum 2009;9: 1598–1604.

21. Boenicke L, Jayne DG, Kim M. What Happens in Stapled Transanal Rectum Resection? Dis Colon Rectum 2011;5:593–600.

22. RomanH, Michot F. Long-Term Outcomes of Transanal Rectocele Repair. Dis Colon Rectum 2005;3:510–517.

23. Oom DMJ, Gosselink P, vanWijk JJ, vanDijland VRM, Schouten WR. Enterocele repair by abdominal obliteration of the pelvic inlet: long-term outcome on obstructed defaecation and symptoms of pelvic discomfort. Colorectal Dis 2007;2:845–850.

24. Gürlich R, Sixta B, Drastich P, Beneš M, Čermák J, Oliverius M, Šváb J. Laparoskopická rektopexe. Rozhl Chir 2006;5:233–235.

25. Vlček P, Čapov I, Jedlička V, Chalupník Š, Korbička J, Veverková L, Doležel J, Jeřábek J, Wechsler J. Robotické výkony v kolorektální chirurgii. Rozhl Chir 2008;3:135–137.

26. Steensma AB, Oom DMJ, Burger CW, Schouten WR. Assessment of posterior compartment prolapse: a comparison of evacuation proctography and 3D transperineal ultrasound. Colorectal Dis 2010;5:533–539.

27. Corman ML, Carriero A, Hager T. Consensus conference on the stapled transanal rectal resection (STARR)for disordered defaecation. Colorectal Dis 2006;1:98–101.

28. Boccasanta P, Venturi M, Salamina G, Cesana BM, Bernasconi F, Roviaro G. New trends in the surgical treatment of outlet obstruction:clinical and functional results of two novelt ransanal stapled techniques from a randomised controlled trial. Int J Colorectal Dis 2004;19:359–369.

29. Renzi A, Izzo D, DiSarno G, Izzo D, DiMartino N. Stapled transanal rectal resection to treat obstructed defecation caused by rectal intussusception and rectocele. Int J Colorectal Dis 2006;1:1–7.

Labels
Surgery Orthopaedics Trauma surgery
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account