Diseases of the Colon & Rectum

Skip Navigation LinksHome > October 2009 - Volume 52 - Issue 10 > Stapled Transanal Rectal Resection for Obstructed Defecation...
Diseases of the Colon & Rectum:
doi: 10.1007/DCR.0b013e3181b550bf
Original Contribution

Stapled Transanal Rectal Resection for Obstructed Defecation: A Cautionary Tale.

Titu, Liviu V. M.D.1; Riyad, Kallingal F.R.C.S.1; Carter, Helen1; Dixon, Anthony R. M.D.1,2

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PURPOSE: This prospective study was designed to assess the efficacy and safety of a novel technique in treating outlet obstruction syndrome using a transanal double-stapling procedure.

METHODS: Two hundred thirty patients (187 female) with obstructed defecation underwent stapled transanal rectal resection over a six-year period with follow-up at 2, 6, and 12 months, then yearly; median follow-up was 24 (range, 12-68) months. All failed conservative measures. Patients with slow transit constipation and puborectalis dyssynergia were excluded.

RESULTS: Operating time was short (median, 35 (range, 20-95) minutes), with 159 (69%) performed as day cases (outpatient). Major complications were seen in 16 (7%); there were no deaths. Twelve (5%) patients reported severe postoperative pain. Immediate postoperative fecal urgency was reported by 107 (46%) patients, but persisted at six months in only 26 (11%). Three (1%) developed recurrent rectal prolapse. Nearly all incontinent patients (98%) reported an improvement, with a median Wexner score reduction of 5 points (P < 0.0001). Constipation improved in 77% of patients. Seventy-seven percent of patients were very glad they had the operation, and 86% recommended stapled transanal rectal resection to a friend.

CONCLUSION: Stapled transanal rectal resection can be performed on a day-case basis with high levels of patient satisfaction. Incontinence and constipation are improved. However, significant morbidity occurs in 7% of patients, and urgency of defecation persists beyond six months in 11%.

© The ASCRS 2009


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