Stapled Trans-Anal Rectal Resection (STARR) for Obstructive Defecation Syndrome—Functional Outcome and Quality of Life after Two Years

Mike Ralf  Langenbach; Alexandre  Berengolts

doi:10.4236/ijcm.2016.73022

Mike Ralf Langenbach^*, Alexandre Berengolts

Abstract: Background: Stapled transanal rectal resection (STARR) has been shown to improve patients’ functional and quality of life outcomes in several studies. Although it is a safe and effective treatment for obstructive defecation syndrome, still data on long-term follow-up are missing. Methods: From January 2010 to July 2014, 46 consecutive patients undergoing STARR using the CONTOUR® TRANSTAR™ device, shortly named TRANSTAR (transanal stapler assisted resection), were prospectively followed. Recurrence rate, quality of life (Patient Assessment of Constipation-Quality of Life (PAC-Qol)) and complication were documented at baseline, 12 and 24 months after operation. Two subgroups of patients were compared to assess the impact of resection length on outcome. Results: We included 46 patients (89% female) in the study. The mean age was 65 ± 16 years and the duration of the operation was 48 ± 4 min. Total PAC-QoL score improved from 2.0 (SD 0.3) to 0.9 (1.4) after 12 months, but deteriorated to 1.2 (0.3) after 24 months (p < 0.001 for both comparisons). Complications were noted in 7% of the patients: Urinary retention (2 patients), postoperative bleeding (1 patient). No major complications or mortality were seen. After one year, we had one prolapse recurrence and after 24 month we had another. There was no significant relation between the length of the specimen and the improvement of life quality. Conclusions: The STARR procedure seems to be a safe and fast therapeutic option for patients with ODS and/or rectal prolapse. It is a tailored transanal full-thickness rectal resection improving the patients’ quality of life still two years after the operation.

Keywords: STARR, Obstructive Defecation Syndrome, External Rectal Prolapse, Transanal Approach, Constipation

Cite this paper: Langenbach, M. and Berengolts, A. (2016) Stapled Trans-Anal Rectal Resection (STARR) for Obstructive Defecation Syndrome—Functional Outcome and Quality of Life after Two Years. International Journal of Clinical Medicine, 7, 217-224. doi: 10.4236/ijcm.2016.73022.

References

[1] Riss, S. and Stift, A. (2015) Surgery for Obstructed Defecation Syndrome—Is There an Ideal Technique. World Journal of Gastroenterology, 21, 1-5.
http://dx.doi.org/10.3748/wjg.v21.i1.1

[2] Dik, V.K., Siersema, P.D., Joseph, A., Hodgkins, P., Smeets, H.M. and van Oijen, M.G. (2014) Constipation-Related Direct Medical Costs in 16,887 Patients Newly Diagnosed with Chronic Constipation. European Journal of Gastroenterology & Hepatology, 26, 1260-1266.
http://dx.doi.org/10.1097/MEG.0000000000000167

[3] Higgins, P.D. and Johanson, J.F. (2004) Epidemiology of Constipation in North America: A Systematic Review. The American Journal of Gastroenterology, 99, 750-9.
http://dx.doi.org/10.1111/j.1572-0241.2004.04114.x

[4] Lembo, A. and Camilleri, M. (2003) Chronic Constipation. The New England Journal of Medicin, 349, 1360-1368.
http://dx.doi.org/10.1056/NEJMra020995

[5] Janssen, L.W. and van Dijke, C.F. (1994) Selection Criteria for Anterior Rectal Wall Repair in Symptomatic Rectocele and Anterior Rectal Wall Prolapse. Diseases of the Colon & Rectum, 37, 1100-7.
http://dx.doi.org/10.1007/BF02049811

[6] Murthy, V.K., Orkin, B.A., Smith, L.E. and Glassman, L.M. (1996) Excellent Outcome Using Selective Criteria for Rectocele Repair. Diseases of the Colon & Rectum, 39, 374-378.
http://dx.doi.org/10.1007/BF02054049

[7] Wijffels, N.A., Jones, O.M., Cunningham, C., Bemelman, W.A. and Lindsey, I. (2013) What Are the Symptoms of Internal Rectal Prolapse? Colorectal Disease, 15, 368-373.
http://dx.doi.org/10.1111/j.1463-1318.2012.03183.x

[8] Ribaric, G., D’Hoore, A., Schiffhorst, G. and Hempel, E. (2014) STARR with CONTOUR(R) TRANSTARTM Device for Obstructed Defecation Syndrome: One-Year Real-World Outcomes of the European TRANSTAR Registry. International Journal of Colorectal Disease, 29, 611-622.
http://dx.doi.org/10.1007/s00384-014-1836-8

[9] Podzemny, V., Pescatori, L.C. and Pescatori, M. (2015) Management of Obstructed Defecation. World Journal of Gastroenterology, 21, 1053-1060.
http://dx.doi.org/10.3748/wjg.v21.i4.1053

[10] Marquis, P., De La Loge, C., Dubois, D., McDermott, A. and Chassany, O. (2005) Development and Validation of the Patient Assessment of Constipation Quality of Life questionnaire. Scandinavian Journal of Gastroenterology, 40, 540-51.
http://dx.doi.org/10.1080/00365520510012208

[11] Jayne, D.G. and Finan, P.J. (2005) Stapled Transanal Rectal Resection for Obstructed Defaecation and Evidence-Based Practice. British Journal of Surgery, 92, 793-4.
http://dx.doi.org/10.1002/bjs.5092

[12] Formijne Jonkers, H.A., Draaisma, W.A., Wexner, S.D., Broeders, I.A., Bemelman, W.A., Lindsey, I., et al. (2013) Evaluation and Surgical Treatment of Rectal Prolapse: An International Survey. Colorectal Disease, 15, 115-119.
http://dx.doi.org/10.1111/j.1463-1318.2012.03135.x

[13] Romano, G., Bianco, F. and Caggiano, L. (2009) Modified Perineal Stapled Rectal Resection with Contour Transtar for Full-Thickness Rectal Prolapse. Colorectal Disease, 11, 878-881.
http://dx.doi.org/10.1111/j.1463-1318.2009.01901.x

[14] Ris, F., Colin, J.F., Chilcott, M., Remue, C., Jamart, J. and Kartheuser, A. (2012) Altemeier’s Procedure for Rectal Prolapse: Analysis of Long-Term Outcome in 60 Patients. Colorectal Disease, 14, 1106-1111.
http://dx.doi.org/10.1111/j.1463-1318.2011.02904.x

[15] Shorvon, P.J., McHugh, S., Diamant, N.E., Somers, S. and Stevenson, G.W. (1989) Defecography in Normal Volunteers: Results and Implications. Gut, 30, 1737-1749.
http://dx.doi.org/10.1136/gut.30.12.1737

[16] Khaikin, M. and Wexner, S.D. (2006) Treatment Strategies in Obstructed Defecation and Fecal Incontinence. World Journal of Gastroenterology, 12, 3168-3173.

[17] Ribas, Y., Hotouras, A. and Munoz-Duyos, A. (2014) Comment on Ribaric et al.: STARR with CONTOUR(R) TRANSTARTM Device for Obstructed Defecation Syndrome: One-Year Real-World Outcomes of the European TRANSTAR Registry. International Journal of Colorectal Disease, 29, 1583-1584.
http://dx.doi.org/10.1007/s00384-014-1952-5

[18] Wolff, K., Marti, L., Beutner, U., Steffen, T., Lange, J. and Hetzer, F.H. (2010) Functional Outcome and Quality of Life after Stapled Transanal Rectal Resection for Obstructed Defecation Syndrome. Diseases of the Colon & Rectum, 53, 881-888.
http://dx.doi.org/10.1007/DCR.0b013e3181cdb445

[19] Renzi, A., Talento, P., Giardiello, C., Angelone, G., Izzo, D. and Di Sarno, G. (2008) Stapled Trans-Anal Rectal Resection (STARR) by a New Dedicated Device for the Surgical Treatment of Obstructed Defaecation Syndrome Caused by Rectal Intussusception and Rectocele: Early Results of a Multicenter Prospective Study. International Journal of Colorectal Disease, 23, 999-1005.
http://dx.doi.org/10.1007/s00384-008-0522-0

[20] Savastano, S., Valenti, G., Cavallin, F. and Missaglia, C. (2012) STARR with PPH-01 and CCS30 Contour Transtar for Obstructed Defecation Syndrome. Surgical Innovation, 19, 171-174.
http://dx.doi.org/10.1177/1553350611425504

[21] Martellucci, J., Talento, P. and Carriero, A. (2011) Early Complications after Stapled Transanal Rectal Resection Performed Using the Contour(R) Transtar Device. Colorectal Disease, 13, 1428-1431.
http://dx.doi.org/10.1111/j.1463-1318.2010.02466.x

[22] Tschuor, C., Limani, P., Nocito, A., Dindo, D., Clavien, P.A. and Hahnloser, D. (2013) Perineal Stapled Prolapse Resection for External Rectal Prolapse: Is It Worthwhile in the Long-Term? Techniques in Coloproctology, 17, 537-540.
http://dx.doi.org/10.1007/s10151-013-1009-8

[23] Watts, A.M. and Thompson, M.R. (2000) Evaluation of Delorme’s Procedure as a Treatment for Full-Thickness Rectal Prolapse. British Journal of Surgery, 87, 218-222.
http://dx.doi.org/10.1046/j.1365-2168.2000.01342.x

[24] Schulte, T., Bokelmann, F., Jongen, J., Peleikis, H.G., Fandrich, F. and Kahlke, V. (2008) Mediastinal and Retro-/Intraperitoneal Emphysema after Stapled Transanal Rectal Resection (STARR-operation) Using the Contour Transtar Stapler in Obstructive Defecation Syndrome. International Journal of Colorectal Disease, 23, 1019-1020.
http://dx.doi.org/10.1007/s00384-008-0516-y

[25] Gelos, M., Frommhold, K. and Mann, B. (2010) Severe Mesorectal Bleeding after Stapled Transanal Rectal Resection (STARR-Operation) Using the “Contour Transtar curved cutter Stapler”. Colorectal Disease, 12, 265-266.
http://dx.doi.org/10.1111/j.1463-1318.2009.01965.x