Stapled Transanal Rectal Resection Versus Transvaginal Procedure for Treatment of Rectocele_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YIN Shuhui ¹ , ZHAO Ke ¹ , HOU Qingxiang ² , DING Jianhua ¹

1.Department of Colorectal Surgery, The Second Artillery General Hospital of PLA, The Center of Colorectal Disease of PLA, Beijing 100088, China;;
2.Department of Gynaecology and Obstetrics, The Second Artillery General Hospital of PLA, Beijing 100088, China;

Corresponding author：

Keywords：

Stapled transanal rectal resection; Vaginal bridge repair suture; Rectocele; Obstructed defecation syndrome

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Objective Both stapled transanal rectal resection (STARR) and vaginal bridge repair are new operative techniques for treatment of rectocele transanal and transvaginal, respectively. In this study we observe the clinical outcomes for STARR as compared with vaginal bridge repair procedure.
Methods The clinical data of 31 patients with obstructive defecation syndrome from January 2007 to May 2009 were retrospectively analyzed. The patients were divided into 2 groups according to different operative approach: STARR group (n=18) and bridge repair suture group (n=13). The clinical outcomes observed were operative time, blood loss, length of stay, cost of hospitalization, complication and the improvement of obstructed defecation syndrome.
Results There was no difference in the age and severity in the patients of two groups. Evaluation of the clinical outcomes showed 16 (88.9%) patients in the STARR group and 6 (46.2%) in the bridge repair suture group reported improvement in symptoms (P=0.017). STARR had a shorter operative time (24.6 min vs. 33.2 min， P lt;0.01), less estimated blood loss (3.9 ml vs. 16.2 ml， P lt;0.01), more costly (10 743 yuan vs. 3 543 yuan, P lt;0.01) and a higher anal incontinenc rate but reversible. The length of stay was similar (average 6 d). Conclusion The stapled transanal rectal resection procedure is more superior to the vaginal bridge repair suture for improvement of obstructed defecation syndrome from rectocele, however, it has a higher cost and some patient with reversible slight anal incontinence after surgery.

Citation： YIN Shuhui ,ZHAO Ke,HOU Qingxiang,DING Jianhua. Stapled Transanal Rectal Resection Versus Transvaginal Procedure for Treatment of Rectocele. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(2): 129-132. doi: Copy

1.	朱兰，郎景和，丁小曼，等. 阴道后壁“桥”式缝合术的应用 [J]. 中华妇产科杂志， 2005； 40（12）： 859860.
2.	Longo A. Obstructed defecation because of rectal pathologies. Novel surgical treatment: stapled transanal resection(STARR). Annual Cleveland Clinic Florida Colorectal Disease Symposium. January 2005; Ft. Lauderdale, FL.
3.	Boccasanta P, Venturi M, Salamina G, et al. New trends in the surgical treatment of outlet obstruction: clinical and functional results of two novel transanal stapled techniques from a randomised controlled trial [J]. Int J Colorectal Dis, 2004; 19(4): 359369.
4.	Corman ML, Carriero A, Hager T, et al. Consensus conference on the stapled transanal rectal resection (STARR) for disordered defaecation [J]. Colorectal Dis, 2006; 8(2): 98101.
5.	Ommer A, Albrecht K, Wenger F, et al. Stapled transanal rectal resection (STARR): a new option in the treatment of obstructive defecation syndrome [J]. Langenbecks Arch Surg, 2006; 391(1): 3237.
6.	Ellis CN. Stapled transanal rectal resection (STARR) for rectocele [J]. J Gastrointest Surg, 2007; 11(2): 153154.
7.	Schwandner O, Stuto A, Jayne D, et al. Decisionmaking algorithm for the STARR procedure in obstructed defecation syndrome: position statement of the group of STARR pioneers [J]. Surg Innov, 2008; 15(2): 105109.
8.	Guarnieri A, Cesaretti M, Tirone, A, et al. Stapled transanal rectal resection (STARR) in the treatment of rectocele: personal experience [J]. Chir Ital, 2008; 60(2): 243248.
9.	Lehur PA, Stuto A, Fantoli M, et al. Outcomes of stapled transanal rectal resection vs. biofeedback for the treatment of outlet obstruction associated with rectal intussusception and rectocele: a multicenter, randomized, controlled trial [J]. Dis Colon Rectum, 2008; 51(11): 16111618.
10.	丁健华，赵克，朱军, 等. 吻合器经肛直肠切除术治疗出口梗阻型便秘疗效分析 [J]. 中华普通外科杂志， 2009： 24（3）： 249250.
11.	Farouk R, Bhardwaj R, Phillips RK. Stapled transanal resection of the rectum (STARR) for the obstructed defaecation syndrome [J]. Ann R Coll Surg Engl, 2009; 91(4): 287291.
12.	Altomare DF, Spazzafumo L, Rinaldi M, et al. Setup and statistical validation of a new scoring system for obstructed defaecation syndrome [J]. Colorectal Dis， 2008; 10（1）： 8488.
13.	Grassi R, Romano S, Micera O, et al. Radiographic findings of postoperative double stapled trans anal rectal resection (STARR) in patient with obstructed defecation syndrome (ODS) [J]. Eur J Radiol, 2005; 53(3): 410416.
14.	朱兰，王巍. 后盆腔缺陷疾病的手术治疗 [J]. 中国实用妇科与产科杂志， 2006; 22（4）： 318320.
15.	Renzi A, Talento P, Giardiello C, et al. stapled transanal rectal resection (STARR) by a new dedicated device for the surgical treatment of obstructed defaecation syndrome caused by rectal intussusception and rectocele: early results of a multicenter prospective study [J]. Int J Colorectal Dis, 2008; 23(10): 9991005.
16.	Jayne DG, Schwandner O, Stuto A. Stapled transanal rectal resection for obstructed defecation syndrome: oneyear results of the European STARR Registry [J]. Dis Colon Rectum, 2009; 52(7): 12051212.
17.	Slim K, Mezoughi S, LaunaySavary MV, et al. Repair of rectocele using the Stapled TransAnal Rectal Resection (STARR) technique: intermediate results from a multicenter French study [J]. J Chir (Paris), 2008; 145(1): 2731.
18.	Frascio M, Stabilini C, Ricci B, et al. Stapled transanal rectal resection for outlet obstruction syndrome: results and followup [J]. World J Surg, 2008; 32(6): 11101115.
19.	Arroyo A, GonzalezArgente FX, GarciaDomingo M, et al. Prospective multicentre clinical trial of stapled transanal rectal resection for obstructive defaecation syndrome [J]. Br J Surg, 2008; 95(12): 15211527.
20.	Boccasanta P, Venturi M, Stuto A, et al. Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial [J]. Dis Colon Rectum, 2004; 47(8): 12851296.
21.	Gagliardi G, Pescatori M, Altomare DF, et al. Results, outcome predictors, and complications after stapled transanal rectal resection for obstructed defecation [J]. Dis Colon Rectum, 2008； 51(2): 186195.
22.	Harris MA, Ferrara A, Gallagher J, et al. Stapled transanal rectal resection vs. transvaginal rectocele repair for treatment of obstructive defecation syndrome [J]. Dis Colon Rectum, 2009; 52(4): 592597.
23.	孙智晶，朱兰，郎景和. 阴道后壁“桥”式修补术53例临床分析 [J]. 实用妇产科杂志， 2008； 24（4）： 241243.

1. 朱兰，郎景和，丁小曼，等. 阴道后壁“桥”式缝合术的应用 [J]. 中华妇产科杂志， 2005； 40（12）： 859860.
2. Longo A. Obstructed defecation because of rectal pathologies. Novel surgical treatment: stapled transanal resection(STARR). Annual Cleveland Clinic Florida Colorectal Disease Symposium. January 2005; Ft. Lauderdale, FL.
3. Boccasanta P, Venturi M, Salamina G, et al. New trends in the surgical treatment of outlet obstruction: clinical and functional results of two novel transanal stapled techniques from a randomised controlled trial [J]. Int J Colorectal Dis, 2004; 19(4): 359369.
4. Corman ML, Carriero A, Hager T, et al. Consensus conference on the stapled transanal rectal resection (STARR) for disordered defaecation [J]. Colorectal Dis, 2006; 8(2): 98101.
5. Ommer A, Albrecht K, Wenger F, et al. Stapled transanal rectal resection (STARR): a new option in the treatment of obstructive defecation syndrome [J]. Langenbecks Arch Surg, 2006; 391(1): 3237.
6. Ellis CN. Stapled transanal rectal resection (STARR) for rectocele [J]. J Gastrointest Surg, 2007; 11(2): 153154.
7. Schwandner O, Stuto A, Jayne D, et al. Decisionmaking algorithm for the STARR procedure in obstructed defecation syndrome: position statement of the group of STARR pioneers [J]. Surg Innov, 2008; 15(2): 105109.
8. Guarnieri A, Cesaretti M, Tirone, A, et al. Stapled transanal rectal resection (STARR) in the treatment of rectocele: personal experience [J]. Chir Ital, 2008; 60(2): 243248.
9. Lehur PA, Stuto A, Fantoli M, et al. Outcomes of stapled transanal rectal resection vs. biofeedback for the treatment of outlet obstruction associated with rectal intussusception and rectocele: a multicenter, randomized, controlled trial [J]. Dis Colon Rectum, 2008; 51(11): 16111618.
10. 丁健华，赵克，朱军, 等. 吻合器经肛直肠切除术治疗出口梗阻型便秘疗效分析 [J]. 中华普通外科杂志， 2009： 24（3）： 249250.
11. Farouk R, Bhardwaj R, Phillips RK. Stapled transanal resection of the rectum (STARR) for the obstructed defaecation syndrome [J]. Ann R Coll Surg Engl, 2009; 91(4): 287291.
12. Altomare DF, Spazzafumo L, Rinaldi M, et al. Setup and statistical validation of a new scoring system for obstructed defaecation syndrome [J]. Colorectal Dis， 2008; 10（1）： 8488.
13. Grassi R, Romano S, Micera O, et al. Radiographic findings of postoperative double stapled trans anal rectal resection (STARR) in patient with obstructed defecation syndrome (ODS) [J]. Eur J Radiol, 2005; 53(3): 410416.
14. 朱兰，王巍. 后盆腔缺陷疾病的手术治疗 [J]. 中国实用妇科与产科杂志， 2006; 22（4）： 318320.
15. Renzi A, Talento P, Giardiello C, et al. stapled transanal rectal resection (STARR) by a new dedicated device for the surgical treatment of obstructed defaecation syndrome caused by rectal intussusception and rectocele: early results of a multicenter prospective study [J]. Int J Colorectal Dis, 2008; 23(10): 9991005.
16. Jayne DG, Schwandner O, Stuto A. Stapled transanal rectal resection for obstructed defecation syndrome: oneyear results of the European STARR Registry [J]. Dis Colon Rectum, 2009; 52(7): 12051212.
17. Slim K, Mezoughi S, LaunaySavary MV, et al. Repair of rectocele using the Stapled TransAnal Rectal Resection (STARR) technique: intermediate results from a multicenter French study [J]. J Chir (Paris), 2008; 145(1): 2731.
18. Frascio M, Stabilini C, Ricci B, et al. Stapled transanal rectal resection for outlet obstruction syndrome: results and followup [J]. World J Surg, 2008; 32(6): 11101115.
19. Arroyo A, GonzalezArgente FX, GarciaDomingo M, et al. Prospective multicentre clinical trial of stapled transanal rectal resection for obstructive defaecation syndrome [J]. Br J Surg, 2008; 95(12): 15211527.
20. Boccasanta P, Venturi M, Stuto A, et al. Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial [J]. Dis Colon Rectum, 2004; 47(8): 12851296.
21. Gagliardi G, Pescatori M, Altomare DF, et al. Results, outcome predictors, and complications after stapled transanal rectal resection for obstructed defecation [J]. Dis Colon Rectum, 2008； 51(2): 186195.
22. Harris MA, Ferrara A, Gallagher J, et al. Stapled transanal rectal resection vs. transvaginal rectocele repair for treatment of obstructive defecation syndrome [J]. Dis Colon Rectum, 2009; 52(4): 592597.
23. 孙智晶，朱兰，郎景和. 阴道后壁“桥”式修补术53例临床分析 [J]. 实用妇产科杂志， 2008； 24（4）： 241243.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Stapled Transanal Rectal Resection Versus Transvaginal Procedure for Treatment of Rectocele

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