Predictive factors for postoperative constipation and continence after stapled transanal rectal resection

Area of Science:

• Colorectal surgery
• Gastroenterology
• Pelvic floor disorders

Background:

• Stapled transanal rectal resection (STARR) is a key treatment for obstructive defecation syndrome (ODS).
• Objective data predicting STARR success or failure are currently limited.
• Understanding predictive factors is crucial for optimizing patient selection and outcomes.

Purpose of the Study:

• To identify objective parameters predicting success and failure after STARR surgery.
• To analyze factors influencing postoperative constipation and incontinence.
• To inform the therapeutic algorithm for STARR procedures.

Main Methods:

• Prospective data collection from a multi-institutional STARR registry.
• Inclusion of medical history, clinical, and radiomorphological data.
• Univariable and multivariable analyses to identify predictive factors for constipation (CCS) and incontinence (CCIS).

Main Results:

• 181 patients with a median follow-up of 19.4 months were analyzed.
• Overall constipation (CCS) significantly improved, but 17.1% experienced persistent constipation.
• New-onset fecal incontinence (CCIS) occurred in 8.8% of patients.
• Rectocele and intussusception predicted lower CCS; intussusception and enterocele predicted lower CCIS.
• Small rectal diameter, low squeeze pressure, and increased pelvic floor descent predicted higher CCIS.

Conclusions:

• Favorable STARR outcomes are associated with rectocele, intussusception, and enterocele.
• Unfavorable outcomes are linked to small rectal diameter, low sphincter pressure, and increased pelvic floor descent.
• These factors should be integrated into STARR therapy algorithms to improve patient selection and surgical planning.