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Long-term Outcome After Transanal Rectal Resection in Patients With Obstructed Defecation Syndrome

Bock, Susanne1; Wolff, Katja M.D.1; Marti, Lukas M.D.1; Schmied, Bruno M. M.D.1; Hetzer, Franc H. M.D.2

doi: 10.1097/DCR.0b013e31827619aa
Original Contribution: Pelvic Floor

BACKGROUND: Stapled transanal rectal resection with a new, curved, multifire stapler (Transtar procedure) has shown promising short- and midterm results for treating obstructed defecation syndrome. However, few results have been published on long-term outcome.

OBJECTIVE: This study aimed to investigate long-term functional results and quality of life after the Transtar procedure.

DESIGN: This is a retrospective study.

SETTING: This study was conducted at a tertiary hospital in Switzerland.

PATIENTS: Seventy consecutive patients (68 female) with obstructed defecation syndrome had a median age of 65 years (range, 20–90).

INTERVENTION: The Transtar procedure was performed between January 2007 and March 2010.

MAIN OUTCOME MEASURES: Postoperative functional results were evaluated with the Symptom Severity Score, Obstructed Defecation Score, and Cleveland Incontinence Score. Quality of life was evaluated with the Fecal Incontinence Quality of Life Score and the SF-36 Health Survey. Data were divided into 4 groups of 1-, 2-, 3-, and 4-year follow-ups.

RESULTS: The functional scores showed significant postoperative improvement throughout the studied period (p = 0.01). The quality-of-life scores showed a tendency for improvement only in the mental components on the SF-36 Health Survey (p = 0.01). Sixteen patients reported postoperative fecal urgency, but this subsided within a few months. Nine patients reported new postoperative episodes of incontinence and required further treatment.

LIMITATIONS: This study was limited by its retrospective nature, the selection bias, and a bias by the small number of questionnaires available for some scores.

CONCLUSION: The Transtar procedure was successful for long-term treatment of obstructed defecation syndrome. Fecal urgency and incontinence were observed, but typically resolved within months. Therefore, the Transtar procedure appears to be a reasonable approach to treating obstructed defecation syndrome in the long term.

1 Department of Surgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland

2 Surgical Clinic, Cantonal Hospital Schaffhausen, Schaffhausen, Switzerland

Financial Disclosure: Drs Hetzer and Marti are consultants at Ethicon Endo-Surgery for the stapled transanal rectal resection (STARR) procedure with Contour Transtar. Ethicon Endo-Surgery was not involved in this study. The other authors declare no financial interest.

Presented at the meeting of the German Society for Surgery, Berlin, Germany, April 24 to 27, 2012, and at the meeting of the German Society for Coloproctology, Munich, Germany, March 15 to 17, 2012.

Correspondence: Franc H. Hetzer, M.D., Surgical Clinic, Kantonsspital Schaffhausen, Geissbergstrasse 81, CH-8208 Schaffhausen, Switzerland. E-mail:

© The ASCRS 2013