Disappointing long-term outcomes after stapled transanal rectal resection for obstructed defecation

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Surgical Outcomes Research

Background:

• Obstructed defecation syndrome (ODS) significantly impacts patient quality of life.
• Stapled transanal rectal resection (STARR) is a surgical option for ODS.
• Assessing STARR's long-term functional and quality of life outcomes is crucial.

Purpose of the Study:

• Evaluate short and long-term functional outcomes post-STARR for ODS.
• Assess quality of life changes in ODS patients after STARR.
• Determine the durability of STARR's effects on ODS.

Main Methods:

• 46 ODS patients with rectocele/intussusception underwent STARR.
• Pre- and post-operative defecography, manometry (UTDV, MTV), MODS, PAC-QOL, and CCF scores were recorded.
• Follow-up ranged from 18 to 48 months, with a median of 42 months.

Main Results:

• STARR showed mild post-operative pain in most patients; 3 developed stenosis.
• Significant improvements in MTV, UTDV, MODS, and PAC-QOL were observed at 6 months.
• Symptomatic recurrence rates increased over time, and QOL scores declined after 18 months.

Conclusions:

• STARR is a safe procedure that initially restores anorectal anatomy and function in ODS patients.
• STARR leads to initial improvements in functional and quality of life scores.
• A high rate of symptomatic recurrence and decline in quality of life scores are anticipated beyond 18 months post-STARR.