Surgery for obstructed defaecation: does the use of the Contour device (Trans-STARR) improve results?

The objective of the study was to assess safety, efficacy and outcomes of stapled transanal rectal resection (STARR) procedure for obstructed defaecation syndrome (ODS) with two stapling devices, PPH01 and Trans-STARR.

Data were collected on all patients undergoing PPH01 or Trans-STARR over a 2 year period. Initially, all were treated using the PPH01 device and during the last 8 months using the Trans-STARR.

During the analysis period, 25 consecutive patients were treated with PPH01 and 27 patients were treated with Trans-STARR. The median follow up was 12 months (range 3-12 months) for the PPH01 group and 6 months (range 3-12 months) for the Trans-STARR group. Although the resected specimen was larger in the Trans-STARR group (P < 0.001), there was no difference in early adverse events, time to discharge or late complications between the groups. In both groups, postoperative urgency was common (occurring more than occasionally in up to 40% at last review) but the incidence was high preoperatively. ODS and symptom severity scores improved with surgery (P < 0.001). However, the degree of improvement was similar with complete resolution of symptoms occurring in 64% of the PPH01 group and 67% of the Trans-STARR group.

Our study shows that both procedures are safe and effective in the surgical treatment of obstructed defaecation but despite a larger resection the Trans-STARR procedure does not offer any additional benefit. A policy of individualizing techniques tailored to the extent of prolapse may be appropriate, but requires further evaluation.