Early complications after stapled transanal rectal resection performed using the Contour® Transtar™ device

Abstract

STARR using the Contour Transtar device seems to be effective for treating obstructed defaecation. However, serious complications may occur.

STARR with CONTOUR® TRANSTAR™ device for obstructed defecation syndrome: one-year real-world outcomes of the European TRANSTAR registry

“…Urge symptoms were reported after a low anterior resection for rectal cancer and observed up to 12 months postoperatively, without requiring any additional therapy [36]. In the treatment of ODS, defecatory urgency was often recorded after STARR and after TRANSTAR [15, 16, 37]. In the majority of patients, the urge symptoms disappeared postoperatively without the need for any additional therapy, irrespective of whether it was observed as a new onset of the symptom or it already persisted as a symptom of the disease at baseline [16, 27, 35].…”

Stapled Transanal Rectal Resection With Contour Transtar for Obstructed Defecation Syndrome

“…The use of pelvic floor rehabilitation to treat the fragmented evacuation as well as the removal of the retained staples may improve the postoperative discomfort experienced by the patient. 25,26 Serious complications such as rectovaginal fistula, rectal perforation, bleeding, or visceral injury are rare but always feared. [20][21][22][23][24][25] In our experience, we reported only 1 rectovaginal fistula, which occurred because of entrapment of the posterior vaginal wall between the branches of the stapler.…”

“…25,26 Serious complications such as rectovaginal fistula, rectal perforation, bleeding, or visceral injury are rare but always feared. [20][21][22][23][24][25] In our experience, we reported only 1 rectovaginal fistula, which occurred because of entrapment of the posterior vaginal wall between the branches of the stapler. This complication, which occurred in the initial phase of our learning curve, was treated by repairing the rectal wall with advancement flap and did not require the creation of a protective stoma.…”

Comments on Long-term Outcome After Transanal Rectal Resection in Patients With Obstructed Defecation Syndrome

“…By contrast, several other groups have reported postoperative incontinence rates ranging from 1.5% to 5%. [2][3][4] We believe that the higher incontinence rate reported by Bock et al can be attributed to insufficient preoperative patient evaluation. Because they used only questionnaires, without anorectal manometry, the authors likely failed to detect a substantial number of patients with underlying sphincter dysfunction.…”

“…it is commonly accepted that a careful study of anal sphincter function is mandatory before scheduling a transanal stapling procedure when there are rectal intussusceptions. [2][3][4][5][6] this avoids the performance of a transtar procedure in patients with anal sphincter hypotonia, who would obtain greater benefit from preoperative pelvic floor rehabilitation. Biofeedback has enabled 60% of these patients to achieve a 90% reduction in the number of incontinence episodes.…”