Obstructed defecation syndrome (ODS ) represents a widespread clinical problem which frequently affects middle-aged females. Nevertheless, many of the previously established techniques are unsuitable for patients with ODS associated with simultaneous rectocele and rectal intussusception. Notably, STARR has been proposed as an alternative operation and a relatively noninvasive surgical technique for this difficult problem. However, some serious complications were documented and there is limited evidence attest to the safety and long-term efficacy of the STARR procedure.
A research article to be published recently on May 28, 2010 in the World Journal of Gastroenterology addresses this question. The research team led by Professor Zhao from the department of Colo-Rectal Disease Surgery of the Second Artillary General hospital evaluated the safety and feasibility of STARR for the management of ODS due to symptomatic rectocele and rectal intussusception, and performed an analysis of 12-month postoperative outcomes. Additionally, they used standardized questionnaires (constipation scoring system, ODS score system, symptom severity score, visual analogue scale and Patient Assessment of Constipation-Quality of Life Questionnaire) represents an essential tool for the clinical staging of ODS for subsequent surgery and for the evaluation of therapeutic results.
This research demonstrated that STARR can be performed safely without major morbidity. Furthermore, the data showed the efficacy of STARR in relieving symptoms of obstructed defecation. At a follow-up of 12 months, the self-reported definitive outcome was reported as excellent by 15 patients (30%), fairly good by 8 (16%), good by 22 (44%), and poor by 5 (10%). Therefore, the symptoms of constipation improved in 90% of patients with noticeable improvements in both the quality of life and the index of satisfaction at 12-months after surgery.
Although the current study indicates a medium-term clinical benefit, longer follow up should be explored to establish the true value of STARR. Moreover, further studies should be realized in order to optimize patient selection and compare the efficacy of this technique with that of other surgical procedures in patients with ODS.
Zhang B, Ding JH, Yin SH, Zhang M, Zhao K. Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception. World J Gastroenterol 2010; 16(20): 2542-2548 www.wjgnet.com/1007-9327/full/v16/i20/2542.htm