Stapled transanal rectal resection to treat obstructed defecation caused by rectal intussusception and rectocele

Obstructed defecation syndrome (ODS) represents a widespread clinical problem. The patients, who are most commonly female and are often middle-aged, can spend several hours a day on the toilet [ 1]. Although in the last decade our understanding of defecation function and dysfunction has improved significantly, the determination of the underlying pathophysiology of ODS is still a challenge today for medical science. New evidence, showing that defecation is an integrated process involving the colon, rectum, anal sphincters, and pelvic floor muscles, suggests the complexity of the pathophysiology of ODS [ 2]. Thus, different mechanisms, either functional or anatomical, could lead to ODS. The aim of most of the present surgical procedures is at the treatment of the most frequent anatomical alteration: the rectocele ( RE). Although various surgical techniques have been described, results are variable with different patterns of complications. Recently, a new surgical technique, stapled transanal rectal resection (STARR), has been reported as a low-morbidity and effective treatment of RE and/or rectal-intussusception ( RI) causing ODS [ 3, 4]. This study was designed to determine the safety and efficacy of a modified STARR in patients with ODS caused by RI and/or RE.