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Obstructed defecation syndrome (ODS) is one of the most widespread clinical problems which frequently affect middle - aged females. There is a new surgical technique called stapled trans-anal rectal resection, (STARR) which makes it possible to remove the anorectal mucosa circumferential and reinforce the anterior anorectal junction wall with the use of a circular stapler. This surgical technique developed by Antonio Longo, was proposed as an effective alternative for the treatment of ODS. In this study we present our preliminary results with the STARR operation for the treatment of ODS. For this purpose, 40 consecutive female patients with ODS due to rectal intussusception (RI) and/or rectocele (RE),were recruited in this prospective clinical study, from May 2008 to October 2010. No major operative or postoperative complications were recorded, and after 12-months follow-up, significant improvement in the ODS score system was observed. The symptoms of constipation improved in 90% of patients, 20% of patients judged their final clinical outcome as excellent, 55% as good, 15% as moderate, with only 10% having poor results. After analyzing our results we can conclude that STARR is an effective and safe procedure for the treatment of obstructed defecation syndrome due to rectal intussusception and/or rectocele, and can be performed safely without major morbidity.

Purpose: To assess both short and long-term functional outcomes and quality of life of patients treated with stapled trans-anal rectal resection (STARR) for obstructed defecation syndrome (ODS). Methods: 46 patients with ODS, due to rectocele and/or rectal intussusceptions were treated with STARR. Data collected included demographics, OR time, pain score using visual analog scale (VAS), and complications. The study included defecographic assessment and anal manometry [Urge to defecate volume (UTDV) and maximum tolerable volume (MTV)], both were done preoperative and 1 year postoperative. Modified obstructed-defecation questionnaire (MODS), patient assessed constipation-quality of life (PAC-QOL) score and Cleveland clinic foundation (CCF) continence score were all recorded preoperative and every 6 months during follow-up. Results: Mean age was 48.4 years. 45 patients had mild postoperative pain (VAS: 1-2). Only one male patient had severe pain (VAS: 7). Three patients developed stenosis at the staple line 6 months postoperative and were dilated manually. Follow-up period range was (18 – 48) and median follow-up period was 42 month. Recurrence rate was 6.5% after 18 months, 10.8% after 36 months and 13 % after 42 months. Significant reduction in maximal tolerable volume (MTP) and urge to defecate volume (UTDV) was recorded. Modified obstructed-defecation questionnaire (MODS) and PAC-QOL showed significant improvement after 6 months and this improvement was maintained for 18 months then rapid decline till the end of follow up period. Conclusions: STARR is a safe surgical procedure that effectively restores anatomy and function of the anorectum in patients with ODS. This correction improves functional and QOL scores, however high rate of symptomatic recurrence and QOL score decline are expected after18 months.