A transanal procedure using TST STARR Plus for the treatment of Obstructed Defecation Syndrome: ‘A mid-term study’

Ren, Xiaobin; Yaseen, S.M.; Cao, Yongli; Liu, W.C.; Shrestha, Sundar; Ding, Zhao; Wu, Yingru; Zheng, Kaiyuan; Qian, Qun; Jiang, Congqing

doi:10.1016/j.ijsu.2016.06.039

Cited by 17 publications

(11 citation statements)

References 31 publications

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“…In Group C, the success rate results to be higher if compared with the already published data ranging from 83.3 to 88.2% 27 with a considerably lower early and longterm postoperative complications rate. 19,[28][29][30][31] The success rate of Group D is consistent with those reported about excisional surgery, around 95%, 32 with a lower postoperative complications and reoperation rates. [7][8][9] However, despite the published review, some long-term studies showed poor global success rates for all HD treatments, such as 65% for CSH, 9 73% for excisional surgery, and 70% for THD.…”

Section: Discussionsupporting

confidence: 85%

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Improvement in Hemorrhoidal Disease Surgery Outcomes Using a New Anatomical/Clinical–Therapeutic Classification (A/CTC)

Naldini¹,

Caminati²,

Sturiale³

et al. 2020

Surg J (N Y)

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Introduction The introduction and diffusion of new techniques for hemorrhoidal surgery have made it clear how much Goligher classification is inadequate in the modern times, lacking in any correlation between anatomical and clinical features to a surgical procedure. The aim of the study was to evaluate if the application of a new classification of hemorrhoidal diseases might lead to an improvement in the postoperative surgical outcomes. Methods From January 2014 to December 2015, all patients undergoing surgery for hemorrhoidal disease were enrolled. The procedures performed were based upon a new anatomical/clinical–therapeutic classification (A/CTC) considering these items: anatomical presentation, symptom types and frequency, associated diseases, and available surgical treatments and their related contraindications. The new classification identified four groups: A (outpatient), B, C, and D (surgical approaches). The overall outcomes were assessed and then stratified by surgical groups. These data were then analyzed in comparison with the published data about all the surgical procedures performed. Results A total of 381 patients underwent surgery and they were stratified as follows: Group B (39), C (202), and D (140). Group B underwent Doppler-guided dearterialization with mucopexies or tissue selective therapy, Group C stapled procedures, and Group D hemorrhoidectomy. The mean follow-up was 30 months. The overall outcomes were: success rate 92.4%, recurrences 7.6%, postoperative complications 4.8%, long-term complications 5.4%, and reoperation rate 2.7%. The success rates stratified by groups were: B, 85%); C, 91.4%; and D, 95.7%. Conclusion The A/CTC proved to be useful in stratifying the patients and choosing the proper treatment for each case. This classification seems to improve the outcome of different surgical procedures if compared with those already published.

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Section: Discussionsupporting

confidence: 85%

“…In Group C, the success rate results to be higher if compared with the already published data ranging from 83.3 to 88.2% 27 with a considerably lower early and long-term postoperative complications rate. 19 28 29 30 31 …”

Section: Discussionmentioning

confidence: 99%

Improvement in Hemorrhoidal Disease Surgery Outcomes Using a New Anatomical/Clinical–Therapeutic Classification (A/CTC)

Naldini¹,

Caminati²,

Sturiale³

et al. 2020

Surg J (N Y)

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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.…”

Section: Discussionmentioning

confidence: 99%

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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“…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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A transanal procedure using TST STARR Plus for the treatment of Obstructed Defecation Syndrome: ‘A mid-term study’

Abstract: The TST STARR Plus is a simple, safe, and effective option for selected patients with ODS. Long-term prospective clinical studies are needed to validate the advantages of this emerging, novel procedure.

Cited by 17 publications

References 31 publications

Improvement in Hemorrhoidal Disease Surgery Outcomes Using a New Anatomical/Clinical–Therapeutic Classification (A/CTC)

Improvement in Hemorrhoidal Disease Surgery Outcomes Using a New Anatomical/Clinical–Therapeutic Classification (A/CTC)

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

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