A Modification of the Stapled TransAnal Rectal Resection (STARR) Procedure for Rectal Prolapse

Lin, Hong-Cheng; He, Qiulan; Huang, Liang; Zhang, Zhengguo; Ren, Donglin

doi:10.1177/1553350618793415

Cited by 6 publications

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“…Following the introduction by Longo in 1998 of the transanal stapled procedure for hemorrhoids, 18 our group and others have translated variants of this technology to patients with obstructed defecation syndrome and related prolapse disorders, 19-21 establishing the feasibility and safety of the use of a larger housing afforded by the tissue-selecting technique (TST) stapler. 9,22 At 36 mm, the large-diameter casing of the stapler permits a greater volume of resection 7 with improved removal of prolapsed tissue under improved visualization during instrumental closure. The modified STARR also avoids the risk of dangerous wall deficiencies between the staple lines sometimes observed with the CCS-30 Contour (Ethicon EndoSurgery Cincinatti, Ohio, USA) stapler.…”

Section: Discussionmentioning

confidence: 99%

“…Both of these aspects are likely to reduce postoperative recurrence and minimize perioperative complications when translated to FTRP practice, where we have recently shown acceptable outcomes in a pilot study with a medium-term follow-up in those patients presenting with limited FTRP (defined as <5 cm in length on maximal straining). 7 In China, when surgically managed, either an Altemeier or a Delorme procedure 8 was the most commonly considered procedure of choice, especially for older FTRP patients. This study evaluates the feasibility and safety of the modified STARR procedure retrospectively, comparing postoperative outcomes with the Delorme operation in a group of patients presenting with limited FTRP.…”

Section: Introductionmentioning

confidence: 99%

“…The technical aspects of the modified STARR procedure have been previously described. 6,7 In brief, surgery was performed by experienced surgeons who had gained their experience with the instrument through extensive practice in performing hemorrhoidopexy and attending FTRP cases. Patients were placed in the prone jack-knife position under either spinal or general anesthesia, and lithotomy position was used in patients with poor cardiopulmonary function or under intravenous anesthesia and local anesthesia.…”

Section: Introductionmentioning

confidence: 99%

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Modified Stapled Transanal Rectal Resection Procedure for Limited Rectal Prolapse: A Viable Alternative to the Delorme Operation

et al. 2020

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Purpose. The optimal surgical approach for full-thickness rectal prolapse (FTRP) remains controversial. In China, patients with limited FTRP (<5 cm in length) are usually managed by perineal surgery. We retrospectively assessed the outcome of Delorme’s procedure and compared it with modified stapled transanal rectal resection (STARR). Methods. The study was conducted in 2 public tertiary referral centers in China with modified STARR or Delorme's procedure performed by experienced surgeons. Outcomes assessed recurrence, operative times, blood loss, complications, length of hospital stay, and continence and constipation scoring. Results. Between December 2012 and May 2019, 65 patients were assessed, including 48 with modified STARR (group 1) and 17 with Delorme’s procedure (group 2). The median follow-up was 22 months (range, 3-86 months). The mean operative time for group 1 was 37.4 ± 17.5 minutes vs 74.3 ± 30.6 minutes for group 2 ( P < .001). The blood loss for group 1 was significantly lower than that for group 2 (17.4 ± 15.9 mL vs 27.8 ± 16.7 mL, respectively; P = .028). There was no significant difference between groups in recurrence (group 1 18.8% vs group 2 23.5%; P = .944) with no effect of operation type. Both procedures showed improvement in constipation and continence scoring with a similar impact. Conclusions. Modified STARR and the Delorme operation are comparable in managing limited FTRP with superior results in operative time and blood loss for STARR.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Modified Stapled Transanal Rectal Resection Procedure for Limited Rectal Prolapse: A Viable Alternative to the Delorme Operation

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“…They argue that the resection of the muscular layer in the STARR procedure is not adequate to strengthen the anterior rectal wall; thus, recurrence can be expected in the future. Some supporters of the STARR procedure also admitted that, so several modified STARR procedures were invented[34,35] to ensure the effectiveness of anterior wall repair. However, none of these modified procedures has been accepted as a gold-standard procedure as the long-term curative effect is not clear.…”

Section: Discussionmentioning

confidence: 99%

Khubchandani’s procedure combined with stapled posterior rectal wall resection for rectocele

Shao

Wang

et al. 2019

WJG

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BACKGROUNDObstructed defecation syndrome (ODS) is a widespread disease in the world. Rectocele is the most common cause of ODS in females. Multiple procedures have been performed to treat rectocele and no procedure has been accepted as the gold-standard procedure. Stapled transanal rectal resection (STARR) has been widely used. However, there are still some disadvantages in this procedure and its effectiveness in anterior wall repair is doubtful. Therefore, new procedures are expected to further improve the treatment of rectocele.AIMTo evaluate the efficacy and safety of a novel rectocele repair combining Khubchandani’s procedure with stapled posterior rectal wall resection.METHODSA cohort of 93 patients were recruited in our randomized clinical trial and were divided into two different groups in a randomized manner. Forty-two patients (group A) underwent Khubchandani’s procedure with stapled posterior rectal wall resection and 51 patients (group B) underwent the STARR procedure. Follow-up was performed at 1, 3, 6, and 12 mo after the operation. Preoperative and postoperative ODS scores and depth of rectocele, postoperative complications, blood loss, and hospital stay of each patient were documented. All data were analyzed statistically to evaluate the efficiency and safety of our procedure.RESULTSIn group A, 42 patients underwent Khubchandani’s procedure with stapled posterior rectal wall resection and 34 were followed until the final analysis. In group B, 51 patients underwent the STARR procedure and 37 were followed until the final analysis. Mean operative duration was 41.47 ± 6.43 min (group A) vs 39.24 ± 6.53 min (group B). Mean hospital stay was 3.15 ± 0.70 d (group A) vs 3.14 ± 0.54 d (group B). Mean blood loss was 10.91 ± 2.52 mL (group A) vs 10.14 ± 1.86 mL (group B). Mean ODS score in group A declined from 16.50 ± 2.06 before operation to 5.06 ± 1.07 one year after the operation, whereas in group B it was 17.11 ± 2.57 before operation and 6.03 ± 2.63 one year after the operation. Mean depth of rectocele decreased from 4.32 ± 0.96 cm (group A) vs 4.18 ± 0.95 cm (group B) preoperatively to 1.19 ± 0.43 cm (group A) vs 1.54 ± 0.82 cm (group B) one year after operation. No other serious complications, such as rectovaginal fistula, perianal sepsis, or deaths, were recorded. After 12 mo of follow-up, 30 patients’ (30/34, 88.2%) final outcomes were judged as effective and 4 (4/34, 11.8%) as moderate in group A, whereas in group B, 30 (30/37, 81.1%) patients’ outcomes were judged as effective, 5 (5/37, 13.5%) as moderate, and 2 (2/37, 5.4%) as poor.CONCLUSIONKhubchandani’s procedure combined with stapled posterior rectal wall resection is an effective, feasible, and safe procedure with minor trauma to rectocele.

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“…Existe otro procedimiento adecuado para pacientes con prolapso rectal el cual es la resección rectal transanal con engrapado; esta técnica quirúrgica ha demostrado una tasa menor en el sangrado perioperatorio en comparación con los otros dos procedimientos perineales tradicionales, sin embargo; no es utilizado con mucha frecuencia debido a la alta tasa complicaciones durante el procedimiento que conlleva a múltiples efectos adversos postquirúrgicos y sus variadas contraindicaciones (3,22,23) .…”

Section: Manejo Quirúrgico M Generalidadesunclassified

Manejo Quirúrgico del Prolapso Rectal

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El prolapso rectal es una patología poco frecuente, de fisiopatología no clara; pero que incluye un trastorno del piso pélvico; además es una enfermedad con un gran impacto en el estilo de vida de los pacientes que lo padecen. Típicamente ocurre en mujeres adultas mayores, pero puede ocurrir en hombres y mujeres de todas las edades. Dentro de las manifestaciones clínicas más frecuentes se incluyen la incontinencia fecal, estreñimiento y la sensación de masa rectal. El diagnóstico puede hacerse únicamente por examen físico o bien, en casos sospechosos puede confirmarse con una defecografía; a su vez, se pueden realizar múltiples estudios complementarios dentro de los que se encuentran: Resonancia Magnética,cistografía,tránsito colónico, manometría anal, latencia del motor terminal del nervio pudendo y una colonoscopia. El envío de estos estudios debe valorarse en forma independiente en cada caso. La piedra angular del tratamiento del prolapso rectal es la cirugía con abordaje abdominal, por su mayor efectividad; o en su defecto, el abordaje perineal. A pesar de ser el tratamiento de elección, a todos los pacientes se les debe instruir de forma inicial sobre el manejo médico, ya que, se disminuyen los síntomas y es posible mejorar la calidad de vida del paciente.

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A Modification of the Stapled TransAnal Rectal Resection (STARR) Procedure for Rectal Prolapse

Abstract: Modified STARR in management of mild rectal prolapse appear to be a safe and effective technique. The initial results would encourage a more formal prospective assessment of this technique as part of a randomized trial for the management of mild rectal prolapse.

Cited by 6 publications

References 27 publications

Modified Stapled Transanal Rectal Resection Procedure for Limited Rectal Prolapse: A Viable Alternative to the Delorme Operation

Modified Stapled Transanal Rectal Resection Procedure for Limited Rectal Prolapse: A Viable Alternative to the Delorme Operation

Khubchandani’s procedure combined with stapled posterior rectal wall resection for rectocele

Manejo Quirúrgico del Prolapso Rectal

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