Stapled transanal rectal resection (STARR): a new option in the treatment of obstructive defecation syndrome

B ackground: Rectocele and distal intussusception are organic causes of outlet obstruction. A new surgical option called the stapled transanal rectal resection (STARR) is described within a prospective study. Patients and methods: Fourteen patients with symptomatic rectocele (four females), rectocele with coexistent intussusception (eight females), and intussusception (two males) underwent STARR procedure. The symptoms were measured by means of a defecation score (0-20 points). Results: Complications included local bleeding postoperatively in two cases, and temporary ischuria in four cases. The subjective sense of pain was low; from day 1 postoperatively five patients did not need any analgetics. Only one female patient had prolonged pelvic pain, without any organic reason. All patients showed improvement in rectal evacuation. The mean score of defecation (0-20 points) decreased from 13 +/- 3 to 4 +/- 3 after 1 month (p < 0.05) and remained low. The overall follow-up was 19 +/- 9 months. Only one male patient with intussusception had defecation disorder again 6 months after surgery. Three patients had temporary urge incontinence. Conclusion: STARR is an effective therapy for obstructive defecation disorder due to a symptomatic rectocele and/or a distal intussusception.