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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

doi: 10.1007/DCR.0b013e3181b550bf
Original Contribution

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%.

1Coloproctology Unit, Frenchay Hospital, North Bristol Hospitals NHS Trust, Bristol, United Kingdom

2Spire Hospital, Bristol, United Kingdom

Read at the meeting of The American Society of Colon and Rectal Surgeons and Tripartite, Boston, Massachusetts, June 7 to 11, 2008.

Address of correspondence: Mr. Tony Dixon, Consultant Colorectal Surgeon, North Bristol Hospitals NHS Trust, Beckspool Road, Frenchay, Bristol BS16 1JE, United Kingdom. E-mail:

© The ASCRS 2009