Stapled Trans-Anal Rectal Resection for Obstructed Defecation Syndrome: Three Year Results of the First Asian Experience

Brij B Agarwal, MD, Shruti Sharma, Dr, Nayan Agarwal, Mr, Kamran Ali, Dr, Karan Goyal, Dr, Krishna A Agarwal, Mr, Satish Saluja, MD, Himanshu Pandey

Sir Ganga Ram Hospital, Dr. Agarwal’s Surgery, University College of Medical Sciences, Vardhman Mahavir Medical College

INTRODUCTION: This study was undertaken to evaluate the efficacy and safety of stapled trans-anal rectal resection (STARR) for the management of obstructed defecation syndrome (ODS) in Asian (Indian) patients.

METHODS AND PROCEDURES: A prospective cases series (April 2008-June 2009) of consecutive consenting STARR candidates suffering with ODS evaluated according to a standardized clinical and imaging protocol with well defined inclusion and exclusion criteria, operated following a standard peri-operative protocol. The patients were operated using PPH03 intruments and followed for improvements in ODS scores and adverse events (as per patient maintained diaries) at week (W) 1, W3, month (M) 3, M6, Year (Y) 1 and Y3. Relationship if any between ODS scores, defecographic findings and intraoperative assessment of rectal intussusception length (IRIL) was studied. The clinical data was analysed with standard statistical tools.

RESULTS

Total n=67 (Males 46+Females 21), Age-55.5Yrs.(13.4)

Age(SD) Yrs. Males;57.6(13.1) Females;50.8(13.1) p value;0.04
Defecographic Findings

n(%) Male(n=46) Female(n=21) Pvalue
Rectal Intussusception 8(17.4) 6 (28.6) 0.296
Anterior Rectocele 36(78.3) 19 (90.5) 0.226
Posterior Rectocele 36(78.3) 2 (9.5) 0.709
IRIL cms.(SD) 2.3 (0.7) 2.4 (0.7) 0.534

ODS Scores improved from18.33 (3.33) to 6.55 (1.8); p value 0.000

Improvement Males-11.48 Females-12.52 p value-0.37

CONCLUSION: STARR is an effective procedure for ODS in Asian population. The improvement in ODS scores is sustainable. Demonstrable internal rectal prolapse / rectal intussusceptions is a good predictor of favorable outcomes. Late onset of new pain after 3 months needs further study.


Session: Poster Presentation

Program Number: P039

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