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Background: Obstructed defecation syndrome (ODS) is one of the commonest constipation related disorders confronted by surgeons in Bangladesh. Stapled transanal rectal resection (STARR) is a novel surgical technique specific for ODS. This study was designed to evaluate the effectiveness of STARR on patients with ODS in Bangladesh. Methods: Thirty (30) female patients (age: 46±13.2 years) with ODS, were selected for this observational study, from July 2016 to July 2019, in a private hospital of Dhaka. Patients were interviewed with standardized questionnaire at study enrolment and up to 3 months postoperatively. Surgical outcome was quantified according to the Longo’s Modified ODS score (MODS). Results: At initial consultation, the mean Longo’s MODS score was 17.6+1.9. Mean operative time was 39+6.2 minutes. Commonest complication was ‘staple line bleeding’ in 24(80%) patients intraoperatively & ‘defecatory urgency’ in 18(60 %) patients postoperatively. At postoperative 3-month follow-up, statistically significant (p

Background: Laparoscopic ventral mesh rectopexy (LVMR) and stapled trans-anal rectal resection (STARR) are effective and well-recognized treatments for symptoms of obstructed defecation syndrome (ODS) in the context of rectal prolapse and rectocele. However, recurrence and postoperative complications including symptomatic grade III/IV hemorrhoids develop in patients undergo LVMR. It was hypothesized that adding STARR to LVMR is effective in improving the clinical symptoms and functional outcomes and reducing the postoperative complications after repair of ODS. Methods/Design: In this prospective, single-blind, randomised trial, consecutive patients aged 18 years or older at a single center in China with ODS are randomly assigned (1:1) to either LVMR or LVMR plus STARR. Functional assessment is done preoperatively and 12 months postoperatively. The primary outcome is the rate of complications started in the hospital and is followed up in the outpatient setting until 12 months after surgery. Patients and those assessing the outcomes were masked to the procedure. The primary analysis is done in the per-protocol population. Outcomes are assessed in the entire cohort. Discussion: This study will add to the scant literature regarding surgical management of ODS.

Background: Stapled transanal rectal resection (STARR) has been shown to improve patients’ functional and quality of life outcomes in several studies. Although it is a safe and effective treatment for obstructive defecation syndrome, still data on long-term follow-up are missing. Methods: From January 2010 to July 2014, 46 consecutive patients undergoing STARR using the CONTOUR&reg TRANSTAR&#8482 device, shortly named TRANSTAR (transanal stapler assisted resection), were prospectively followed. Recurrence rate, quality of life (Patient Assessment of Constipation-Quality of Life (PAC-Qol)) and complication were documented at baseline, 12 and 24 months after operation. Two subgroups of patients were compared to assess the impact of resection length on outcome. Results: We included 46 patients (89% female) in the study. The mean age was 65 ± 16 years and the duration of the operation was 48 ± 4 min. Total PAC-QoL score improved from 2.0 (SD 0.3) to 0.9 (1.4) after 12 months, but deteriorated to 1.2 (0.3) after 24 months (p < 0.001 for both comparisons). Complications were noted in 7% of the patients: Urinary retention (2 patients), postoperative bleeding (1 patient). No major complications or mortality were seen. After one year, we had one prolapse recurrence and after 24 month we had another. There was no significant relation between the length of the specimen and the improvement of life quality. Conclusions: The STARR procedure seems to be a safe and fast therapeutic option for patients with ODS and/or rectal prolapse. It is a tailored transanal full-thickness rectal resection improving the patients’ quality of life still two years after the operation.

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.

L’intervention de STARR permet de traiter les troubles de l’evacuation rectale en pratiquant une resection rectale par voie transanale. La correction d’une rectocele et/ou de la procidence interne du rectum permet ainsi de faciliter la vidange du rectum. Cette methode mini-invasive necessite de respecter, de facon rigoureuse, le protocole operatoire et de bien selectionner les patient(e)s pour pretendre a des resultats satisfaisants et durables.

Background: Laparoscopic Ventral Mesh Rectopexy (LVR) corrects both, internal and external rectal prolapse, improving obstructed defaecation symptoms (ODS) and faecal incontinence. Similarly, Stapled Trans-Anal Rectal Resection (STARR) allows resolution of ODS. However data from retrospective series or prospective trials comparing the two procedures for internal rectal prolapse (IRP, defined as recto-rectal or recto-anal intussusception) are absent. In this matched cohorts study we compared outcomes in terms of surgical complications and functional results of LVR and STARR in order to better understand the ideal surgical approach for IRP. Patients and Methods: All patients underwent preoperative evaluation with defaecating proctography or pelvic dynamic MRI. Only patients with recto-rectal or recto-anal intussusception, rectocoele with or without enterocoele or sigmoidocoele were considered from our prospectively kept database. Patients with concomitant middle and anterior pelvic compartment prolapses, were excluded. Two groups of patients were considered according to the surgical technique (LVR or STARR) and matched for demographics, symptoms and characteristics of the prolapse. Only patients with a minimum of 1 year follow-up were considerd. End-points were surgical complications and functional results expressed as Wexner Constipation Score (WCS) and Faecal Incontinence Severity Index (FISI). Results: Twenty-seven patients who underwent LVR were compared to 27 patients who underwent STARR. After LVR, overall complications rate was 15% similar to STARR (11%), all minor. After LVR, WCS significantly improved to 5+/-3 from preoperative 15+/5 (p 0.03). Constipation improved in 89% and was cured in 81%. Similarly, after STARR, WCS score significantly improved to 6+/-5 from preoperative 16+/-11(p 0.03). Recurrence rate was 22%. Constipation improved in 85% and was cured in 78%. No significative differences were observed between the two groups. Considering incontinence, after LVR the FISI score significantly improved to 2+/-2 from preoperative 7+/-3 (p 0.03). Incontinence improved in 90% and was completely cured in 90%. After STARR, the FISI score improved to 4+/-2 from preoperative 8+/-5(p 0.06). Incontinence improved in 54% and was completely cured in 45%. These percentages were significantly lower compared to those observed after LVR. Conclusions: LVR and STARR seems to be equally valid to treat constipation associated to IRP, but LVR has greater chances to cure incontinence.