Objectives of Study
Stapled transanal rectal resection (STARR) is emerging as a standard of care procedure for the management of obstructed defecation syndrome (ODS). Efficacy of the STARR procedure is promised upon correction of structural abnormality of lower rectum by resecting the lower third rectal segment of about 5 cms. This resection may raise concerns about rectal compliance and attendant problems thereof. We report the first Indian experience of STARR procedure with 6 month follow up.
Methods and procedures
From April 2008 to March 2009, 34 properly selected consecutive candidates of ODS underwent STARR procedure on a day care surgery basis after pre-anesthesia evaluation and following ethics and informed consent protocol. All the patients refractory to gastroenterologists treatment of constipation >6 months were evaluated for ODS by anal anometry, endoanal sonography and dynamic defaecography. Only those with positive findings on defaecography were included. STARR was performed using PPH 03 instruments following a standard peri / post-operative antibiotic and analgesic policy. No post-operative laxatives were prescribed. Clinical follow up visits were scheduled at 1st week (W1), 3rd week (W3), 3rd month (M3) and 6th month (M6). Patients were asked to maintain pain (100 point visual analog scale), defecation (ODS scores) and adverse event diaries. Patient reported outcomes based upon these diaries were analyzed.
- All patients (Males 22, Females 12) were discharged from day care surgery.
- There was no bleeding at staple line, need for uretheral catheterization, postoperative bleeding, incontinence and re-hospitalization or any reported postoperative adverse event.
- Due to improper diaries 4 patients were withdrawn from analysis.
- Mean operating time was 50 (40-55) minutes.
- All patients reported relief from constipation with improvement in mean ODS scores of 18 to less than 5.
- Relief was evident a D3 follow up and maintained throughout the follow up. Mean pain scores were 32 (Day 1), 70 (Day 2), 52 (Day 3), 30(W1), 0 (W3), 0 (M3), 7 (M6).
- Rectal urgency and frequent stools were universally reported with resolution in all by W3 but for a lady who continued to have rectal urgency at M3 that resolved at M6.
- A male patient was found to have a soft stricture at the routine W3 follow up. The stricture was easily dilated with finger and he was fine at M3 after dilatation and till the M6 follow up of STARR.
In our Indian experience ODS affected males more than females. The STARR procedure is an effective remedy for well diagnosed patient of ODS substantiated by dynamic defaecography.
Program Number: P123