Department of General and Visceral Surgery, Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, 01067 Dresden, Germany.
Langenbecks Arch Surg. 2012 Jun;397(5):771-8. doi: 10.1007/s00423-012-0920-1. Epub 2012 Feb 21.
Stapled transanal rectal resection (STARR) has recently been recommended for patients with obstructed defecation caused by rectocele and rectal wall intussusception. Our study investigates the long-term results and predictive factors for outcome.
Between November 2002 and February 2007, 80 patients (69 females) were operated on using the STARR procedure and included in the following study. Symptoms were defined according to the ROME II criteria. Preoperative assessment included clinical examination, colonoscopy, video defecography, and dynamic MRI. Preoperatively and during follow-up visits, we evaluated the Cleveland Constipation Score (CCS) to rate the severity of outlet obstruction and the Wexner Incontinence Score to rate anal incontinence. Patients were asked to judge the outcome of the operation as improved or poor/dissatisfied. We performed a univariate analysis for 11 patient- and disease-related factors to detect an association with outcome.
The median follow-up was 39 months (range 20-78). Major postoperative complications (one staple line insufficiency, one urosepsis, one prolonged urinary dysfunction with indwelling catheter) were found in 3.8%. The result after STARR procedure was a success in the long-term follow-up in 62 patients (77.5%), although the improvement did not persist in 15 patients (18.7%). The mean value of the CCS decreased significantly from 9.3 before surgery to 4.6 after 2 years and increased again slightly to 6.5 after 4-6 years. The Median Wexner Incontinence Score was 3.3 at baseline, but rose significantly to 6.0. However, a third of patients who reported deteriorated continence developed the symptoms 1-4 years after surgery. Of the factors investigated for the prediction of outcome, we could only identify the number of pelvic floor changes in defecography or dynamic MRI as being associated with the success of the operation.
Our study indicates that STARR is a safe procedure. A significant improvement of symptoms is to be expected, but this improvement may deteriorate with time. Patients' satisfaction is also associated with the occurrence of urge to defecate or incontinence. It remains difficult to predict outcome.
吻合器经肛门直肠切除术（STARR）最近被推荐用于因直肠前突和直肠壁套叠引起的排便障碍患者。本研究调查了长期结果和预测结果的因素。
2002 年 11 月至 2007 年 2 月，对 80 例患者（69 例女性）进行了 STARR 手术，并纳入本研究。症状根据 ROME II 标准定义。术前评估包括临床检查、结肠镜检查、视频排粪造影和动态 MRI。在术前和随访期间，我们使用克利夫兰便秘评分（CCS）评估出口梗阻的严重程度，使用 Wexner 失禁评分评估肛门失禁。患者被要求判断手术结果是改善还是差/不满意。我们对 11 项与患者和疾病相关的因素进行了单因素分析，以检测与结果的相关性。
中位随访时间为 39 个月（范围 20-78）。3.8%的患者出现术后主要并发症（1 例吻合线不完整，1 例尿脓毒症，1 例留置导尿管后长期尿功能障碍）。在长期随访中，62 例患者（77.5%）的 STARR 手术结果成功，尽管 15 例患者（18.7%）的改善并未持续。CCS 的平均值从术前的 9.3 显著下降到 2 年后的 4.6，在 4-6 年后又略有上升到 6.5。基线时中位 Wexner 失禁评分是 3.3，但显著上升到 6.0。然而，三分之一报告大便失禁恶化的患者在术后 1-4 年内出现了这些症状。在为预测结果而调查的因素中，我们只能确定排粪造影或动态 MRI 中盆底变化的数量与手术的成功有关。
本研究表明 STARR 是一种安全的手术。预计症状会有显著改善，但这种改善可能会随着时间的推移而恶化。患者的满意度也与急迫排便或失禁的发生有关。预测结果仍然很困难。
