Pelvic floor function following ventral rectopexy versus STARR in the treatment of obstructed defecation

Altomare, D. F.; Picciariello, Arcangelo; Memeo, R.; Fanelli, Margherita; Digennaro, Rosa; Chetta, Nicola; Fazio, Michele De

doi:10.1007/s10151-018-1776-3

Cited by 15 publications

(10 citation statements)

References 25 publications

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“…We analyzed twenty-four studies about STARR technique divided in retrospective, prospective and randomized control trials ( 9 , 10 , 15 , 19 – 39 ) ( Table 2 ). The total number of patients treated with STARR procedure was 4,464.…”

Section: Resultsmentioning

confidence: 99%

“…All patients underwent a preoperative assessment before going to surgery with different tests to evaluate the pelvic floor function and to exclude disorders that could contraindicate surgery ( 9 , 10 , 15 , 19 – 39 ) ( Table 3 ). The almost totality of patients, in all of the analyzed studies, performed a dynamic defecography ( n = 4,512, 99%) and an endoscopic study such as colonoscopy or proctoscopy ( n = 4,276, 94%) and completed the assessment with an anorectal manometry ( n = 4,029, 88%).…”

Section: Resultsmentioning

confidence: 99%

“…As shown in Table 4 ( 9 , 10 , 15 , 19 – 39 ) 85% of patients ( n = 3,876) were evaluated using Obstructed Defecation Syndrome Score (ODS score) obtaining a mean result of 16 out of 36 before surgery. Approximately 22% of patients ( n = 1,018) were also scored according to the Wexner Constipation Score before going to surgery obtaining a mean result of 14.5 (in a range between 0 and 30).…”

Section: Resultsmentioning

confidence: 99%

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Stapled Transanal Rectal Resection (Starr) in the Treatment of Obstructed Defecation: A Systematic Review

et al. 2022

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Obstructed defecation syndrome (ODS) is a form of constipation that influences the quality of life in most patients and is an important health care issue. In 2004 Longo introduced a minimal invasive trans-anal approach known as Stapled Trans-Anal Rectal Resection (STARR) in order to correct mechanical disorders such as rectocele or rectal intussusception, two conditions present in more than 90% of patients with ODS. Considering the lack of a common view around ODS and STARR procedure. the aim of our study is to review the literature about preoperative assessment, operative features and outcomes of the STARR technique for the treatment of ODS. We performed a systematic search of literature, between January 2008 and December 2020 and 24 studies were included in this review. The total number of patients treated with STARR procedure was 4,464. In conclusion STARR surgical procedure has been proven to be safe and effective in treating symptoms of ODS and improving patients Quality of Life (QoL) and should be taken in consideration in the context of a holistic and multi modal approach to this complex condition. International guidelines are needed in order to optimize the diagnostic and therapeutic process and to improve outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Stapled Transanal Rectal Resection (Starr) in the Treatment of Obstructed Defecation: A Systematic Review

et al. 2022

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“…In the past, pelvic oor dyssynergia-type constipation was attributed to rectal protrusion and rectal intussusception and collectively called pelvic oor dysfunction syndrome. According to clinical experience, the postoperative effect in most patients is still not satisfactory due constipation recurrence [11] , regardless of position of rectal mucosa suspension, range of tissue removal or enhanced repair of local muscle tissue. Due to the continuous development of three-dimensional ultrasonography techniques, this method has been increasingly applied to pelvic oor imaging [12] .…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional ultrasonography study of female defecation disorder caused by changes of the puborectalis muscle

Zhang

Liu

Wang³

et al. 2019

Preprint

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Objective To investigate the correlation between pelvic floor dyssynergia-type constipation and the puborectalis muscle using three-dimensional ultrasonography. Methods Eighty-seven patients with pelvic floor dyssynergia-type constipation (observation group) and 87 healthy volunteers (control group) were enrolled in this study. Three-dimensional ultrasonography of the pelvic floor was performed on patients and healthy volunteers in a lithotomy position at rest and during straining and squeezing. The three-dimensional reconstructed sonogram was analysed to determine the puborectalis angle and puborectalis thickness at the 6 o’clock position (patients in a lithotomy position). Results (1) The puborectalis angles of the observation and control groups were not significantly different at rest [(85.664 ± 1.926)°, (85.813 ± 1.500)°] and during squeezing [(87.478 ± 2.125)°, (86.960 ± 1.751)°] (P > 0.05) but were significantly different when straining [(80.389 ± 2.268)°, (94.382 ± 1.540)°] (P < 0.05). The difference in the puborectalis angles of the two groups between rest and straining [(5.275 ± 1.236)°, (-8.569 ± 1.209)°] was statistically significant (P < 0.05). (2) The puborectalis thickness of the observation and control groups was not significantly different at rest ([3.994 ± 0.128) mm, (3.983 ± 0.091) mm] and during anal squeezing [(4.082 ± 0.154) mm, (4.126 ± 0.113) mm] (P > 0.05) but was significantly different when straining [(4.630 ± 0.199) mm, (4.296 ± 0.121) mm] (P < 0.05). The differences in the puborectalis thickness at rest and during straining in the observation and control groups were (-0.636 ± 0.217) mm and (-0.316 ± 0.089) mm, respectively, resulting in a statistically significant difference between the two groups (P < 0.05). Conclusion The puborectalis angle in patients with pelvic floor dyssynergia-type constipation was smaller than that in healthy volunteers during straining. The puborectalis thickness at the 6 o’clock position with the patient in a lithotomy position in patients with pelvic floor dyssynergia-type constipation was larger than that in healthy volunteers. Moreover, larger differences between rest and straining are associated with a more severe degree of constipation. Project funding Natural Science Foundation of Shandong (ZR2012HM086)

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“…In the last 2 years, two publications showed, rather convincingly, the superiority of laparoscopic ventral mesh rectopexy (LVMR) over stapled transanal rectal resection (STARR) in the management of obstructed defecation syndrome (ODS) associated with pelvic structural abnormalities, such as high-grade rectal intussusception and/or large rectocele [1,2]. These papers confirmed the empirical trend in several European referral centers for decreased use of transanal stapling procedures of any type for this frequent and complex condition that intermingles functional and anatomical disorders [3].…”

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confidence: 99%

To staple or not to staple the symptomatic rectocele

2019

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Pelvic floor function following ventral rectopexy versus STARR in the treatment of obstructed defecation

Abstract: VRP and STARR can improve defecation in patients with ODS with minimal complications, but the overall pelvic wellness evaluated by the TAPE score improves significantly only after VRP, suggesting a better performance of VRP than STARR when overall pelvic floor function is concerned.

Cited by 15 publications

References 25 publications

Stapled Transanal Rectal Resection (Starr) in the Treatment of Obstructed Defecation: A Systematic Review

Stapled Transanal Rectal Resection (Starr) in the Treatment of Obstructed Defecation: A Systematic Review

Three-dimensional ultrasonography study of female defecation disorder caused by changes of the puborectalis muscle

To staple or not to staple the symptomatic rectocele

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