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Related Experiment Videos

Reinterventions after complicated or failed STARR procedure.

Mario Pescatori1, Andrew P Zbar

  • 1Coloproctology Unit, Ars Medica Hospital, Rome, 00191, Italy.

International Journal of Colorectal Disease
|August 13, 2008
PubMed
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The stapled transanal rectal resection (STARR) procedure for obstructed defecation often fails when pelvic floor issues are not fully addressed. Reoperation after STARR complications or failure yields poor outcomes, highlighting the need for careful patient selection.

Area of Science:

  • Coloproctology
  • Pelvic Floor Surgery
  • Gastroenterology

Background:

  • The stapled transanal rectal resection (STARR) procedure is used for rectocele-associated evacuatory difficulty.
  • Many patients have multiple pelvic floor pathologies not addressed by a single procedure.
  • This study evaluates STARR outcomes in complicated or failed cases referred to a tertiary unit.

Purpose of the Study:

  • To assess the outcomes of the STARR procedure in an unselected group of patients with complicated or failed treatments.
  • To identify associated pelvic floor pathologies and psychopathology in patients referred after STARR.

Main Methods:

  • Patients underwent comprehensive anorectal, urogynecological, and psychological examinations.
  • Objective scoring systems, ultrasound, manometry, and defecography were used to detect pelvic floor issues.

Related Experiment Videos

  • The Iceberg Diagram was utilized to identify occult pelvic floor pathology.

    • Main Results:

    • Thirteen patients were operated on post-STARR for complications or failures like recurrent obstructed defecation and fecal incontinence.
    • Eleven patients received biofeedback and psychotherapy; four had anal sphincter defects, and seven had significant psychological issues.
    • After reoperation and tailored procedures, six patients with psychoneurosis remained unchanged, while three were asymptomatic and two improved.

    Conclusions:

    • Surgical reintervention following complicated or failed STARR procedures has a poor prognosis.
    • Careful patient selection is crucial, considering associated pelvic floor pathology and pre-existing psychopathology.
    • Addressing multiple pelvic floor disorders and psychological factors is essential for successful treatment.