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Surgical Robot-Assisted Transanal Specimen Extraction Radical Sigmoidectomy Without an Auxiliary Abdominal Incision

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What happens in stapled transanal rectum resection?

Lars Boenicke¹, David G Jayne, Mia Kim

¹Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany. Boenicke_L@chirurgie.uni-wuerzburg.de

Diseases of the Colon and Rectum

|April 8, 2011

Summary

Stapled transanal rectum resection improves constipation by reducing intussusception, rectocele, and pelvic floor descent. However, reduced rectal lumen size after this procedure may cause new-onset fecal urgency and incontinence.

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Area of Science:

Colorectal Surgery
Gastroenterology
Pelvic Floor Disorders

Background:

Stapled transanal rectum resection (STARR) is a popular surgical option for obstructive defecation syndrome (ODS).
The anatomical changes and their correlation with surgical outcomes after STARR are not well understood.
This study aimed to correlate defecographic and clinical patterns post-STARR.

Purpose of the Study:

To analyze the anatomical changes following stapled transanal rectum resection (STARR) using defecography.
To correlate these anatomical changes with clinical outcomes, including constipation and fecal continence.
To identify factors influencing success and potential complications of STARR.

Main Methods:

A multi-institutional registry of 182 patients undergoing STARR was utilized.
Prospective correlation analysis of clinical and radiological parameters was performed on 51 patients with 12-month follow-up.
Defecography was used to assess anatomical changes pre- and post-surgery.

Main Results:

STARR significantly altered intussusception, enterocele, rectocele, rectal lumen size, anorectal angle, and pelvic floor descent.
Reduced intussusception, rectocele, and dynamic pelvic floor descent correlated with improved constipation.
Reduced intussusception improved continence, while reduced rectal lumen size correlated with incontinence and urgency.

Conclusions:

Improvement in constipation after STARR is linked to reduced intussusception, rectocele, and dynamic pelvic floor descent.
Postoperative continence is influenced by intussusception reduction and rectal lumen size, which have opposing effects.
A smaller rectal lumen post-STARR may contribute to new-onset fecal urgency and incontinence.