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

Bock, Susanne; Wolff, Katja; Marti, Lukas; Schmied, Bruno M.; Hetzer, Franc

doi:10.1097/dcr.0b013e31827619aa

Cited by 17 publications

(8 citation statements)

References 20 publications

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“…There was, however, a slight deterioration in clinical status over time, with the principal symptoms minimized at 1 post-operative year but gradually worsening over a more prolonged follow-up. Our results are akin to previously reported literature where there is a trend for constipation scores to increase only after 2 years of post-operative follow-up [ 19 ]. It is likely that these findings are indicative of a slow change in the anatomy that ultimately results in late relapse, suggesting the need to assess post-STARR patients beyond a few years.…”

Section: Discussionsupporting

confidence: 87%

Prognostic and predictive value of interstitial cells of Cajal populations following stapled transanal rectal resection (STARR) in patients with obstructed defecation syndrome

Lin

Huang

Zhu

et al. 2018

Gastroenterology Report

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ObjectiveThe present study was designed to evaluate the functional outcome of stapled transanal rectal resection (STARR) and to examine the relationship between the population density of the interstitial cells of Cajal (ICC) and the efficacy of the STARR operation in the management of obstructed defecation syndrome (ODS) patients.MethodsFull-thickness rectal samples were obtained from 50 ODS patients who underwent STARR. Samples were analysed using ICC immunohistochemistry. Clinical and functional parameters obtained with defecography and anorectal manometry were compared with 20 controls.ResultsICCs were significantly decreased in patients in the submucosal (SM), intramuscular (IM) and myenteric (MY) regions when compared with the control group (P < 0.05). The mean pre-operative Cleveland Constipation Score (CCS) was 24.2 ± 4.1, whilst the CCS at 1, 2, 3, 4 and 5 years post-operatively decreased significantly (P < 0.05). At 3 post-operative years, 58.3% (28/48) of the patients reported a favorable outcome (CCS ≤ 10). On univariate analysis, the functional results were worse in those with pre-operative digitation (P = 0.017), a decreased ICC-MY cell population (P = 0.067), a higher resting anal canal pressure (P = 0.039) and a higher rectal sensory threshold (P = 0.073). Multivariate analysis showed the decreased ICC-MY cell population was an independent predictor for low unfavorable functional outcome (odds ratio = 0.097, 95% confidence interval: 0.012–0.766).ConclusionsSTARR achieved acceptable results at the cost of a slight deterioration over a more prolonged follow-up. Patients with a decreased ICC number in the rectal specimen showed an unfavorable functional outcome where pre-operative histological assessment of a full-thickness rectal sample might predict for the functional outcome following STARR.

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Section: Discussionsupporting

confidence: 87%

Prognostic and predictive value of interstitial cells of Cajal populations following stapled transanal rectal resection (STARR) in patients with obstructed defecation syndrome

Lin

Huang

Zhu

et al. 2018

Gastroenterology Report

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“…To the Editor-We read with great interest the article entitled "long-term outcome after transanal Rectal Resection in Patients With obstructed Defecation syndrome" by Bock et al 1 in that study, the authors investigated the long-term functional outcomes and quality of life of patients who had undergone the transtar procedure. they reported an unexpectedly high overall postoperative incontinence rate (23%), with a 13% incidence of new-onset symptoms.…”

Section: Comments On Long-term Outcome After Transanal Rectal Resectimentioning

confidence: 98%

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

Mari¹,

Cesare²,

Nigri³

et al. 2013

Diseases of the Colon &Amp; Rectum

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“…In the recent STARR literature, there is a trend toward omitting this distinction, referring to the STARR procedure simply as a "treatment for ODS," [79][80][81][82][83] with ODS regarded as a single entity caused by mechanical obstruction of stool by internally prolapsing tissue. 84 Even if the studies themselves have more stringent inclusion criteria, the description of STARR as an "operation for ODS" is problematic. Generalizing ODS as a single entity that can be cured with a stapler is a dramatic reversal of everything we have learned about the complex physiologic and psychological mechanisms that contribute to a patient's inability to evacuate stool.…”

Section: Transanal Resectionmentioning

confidence: 99%

Functional Disorders: Rectocele

2016

Clinics in Colon and Rectal Surgery

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Rectoceles are a very common finding in patients, and symptoms most commonly include pelvic pain, pressure, or difficulty with passing stool. However, there are often other associated pelvic floor disorders that accompany rectoceles, making the clinical significance of it in an individual patient often hard to determine. When evaluating a patient with a rectocele, a thorough history and physical exam must be conducted to help delineate other causes of these symptoms. Treatment consists of addressing other defecatory disorders through various methods, with surgery reserved for select cases in which obstructed defecation is well documented.

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

Cited by 17 publications

References 20 publications

Prognostic and predictive value of interstitial cells of Cajal populations following stapled transanal rectal resection (STARR) in patients with obstructed defecation syndrome

Prognostic and predictive value of interstitial cells of Cajal populations following stapled transanal rectal resection (STARR) in patients with obstructed defecation syndrome

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

Functional Disorders: Rectocele

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