Stapled transanal rectal resection for obstructed defecation: a cautionary tale.

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Outlet obstruction syndrome (OOS) significantly impacts quality of life.
• Conservative management often fails for OOS patients.
• Transanal surgical techniques are evolving for OOS treatment.

Purpose of the Study:

• To evaluate the efficacy and safety of transanal double-stapling for OOS.
• To assess patient-reported outcomes and complication rates.
• To determine the feasibility of day-case surgery for this procedure.

Main Methods:

• Prospective study of 230 OOS patients undergoing stapled transanal rectal resection (STARR).
• Exclusion of patients with slow transit constipation or puborectalis dyssynergia.
• Follow-up at 2, 6, 12 months, then yearly, with a median of 24 months.

Main Results:

• High patient satisfaction (77% "very glad", 86% recommended).
• Significant improvement in incontinence (98% improved, Wexner score reduced by 5 points) and constipation (77% improved).
• Short operating time (median 35 min), 69% day cases; 7% major complications, 11% persistent urgency at 6 months.

Conclusions:

• Stapled transanal rectal resection is a viable day-case option for OOS with high patient satisfaction.
• The procedure effectively improves symptoms of incontinence and constipation.
• Careful patient selection is crucial due to potential significant morbidity (7%) and persistent urgency (11%).