Department of General Surgery, Villa Tiberia Hospital, Via Emilio Praga, 26, 00100, Rome, Italy.
Colorectal Surgery Unit, Department of General Surgery, Mansoura University, Mansoura, Dakahlia, Egypt.
Tech Coloproctol. 2019 Mar;23(3):231-237. doi: 10.1007/s10151-019-01944-9. Epub 2019 Feb 16.
This study aims to investigate functional results and recurrence rate after stapled transanal rectal resection (STARR) for rectocele associated with obstructive defection syndrome (ODS).
A study was conducted on patients with ODS symptoms associated with symptomatic rectocele ≥ 3 cm on dynamic defecography who had STARR at our institution between 01/2007 and 12/2015. Data were prospectively collected and analyzed. ODS was evaluated using the Wexner constipation score. Primary outcomes were functional results, determined by the improvement in 6-month postoperative Wexner constipation score, and 1-year recurrence. Secondary outcomes were operative time, time to return to work, pain intensity measured using the visual analogue scale (VAS), patient satisfaction, and overall postoperative morbidity and mortality at 30 days.
Two-hundred-sixty-two consecutive female patients [median age 54 years (range 20-78)] were enrolled in the study. The median duration of follow-up was 79 months (range 30-138). Sixty (23%) patients experienced postoperative complications, but only 9 patients required reinterventions for surgical hemostasis (n = 7), fecal diversion for anastomotic leakage (n = 1), and recto-vaginal fistula repair (n = 1). Only 1 intraoperative complication (stapler misfire) was reported, and there were no deaths. There was a statistically significant (p < 0.001) reduction in the median (range) Wexner constipation score from 19 (14-24) preoperatively to 9 (5-15) 6 months postoperatively. Only 10 (4%) patients experienced recurrence and only 3 of them required additional reintervention. Patient satisfaction at 1 year was excellent in 86%, good in 13%, and poor in 1% of patients.
STARR is a safe, effective, and minimally invasive technique for the treatment of rectocele associated with ODS.
本研究旨在探讨吻合器经肛直肠切除术（STARR）治疗伴有阻塞性排便障碍综合征（ODS）的直肠前突的功能结果和复发率。
对 2007 年 1 月至 2015 年 12 月在我院行 STARR 治疗伴有症状性直肠前突且动态排粪造影提示直肠前突≥3cm 的 ODS 症状患者进行前瞻性研究，收集并分析数据。ODS 采用 Wexner 便秘评分评估。主要结果为术后 6 个月 Wexner 便秘评分改善的功能结果和 1 年复发情况。次要结果为手术时间、恢复工作时间、视觉模拟量表（VAS）测量的疼痛强度、患者满意度以及 30 天的总术后发病率和死亡率。
262 例连续女性患者（中位年龄 54 岁[范围 20-78]）纳入研究。中位随访时间为 79 个月（范围 30-138）。60 例（23%）患者发生术后并发症，但仅 9 例（7 例因吻合口出血需再次手术止血、1 例因吻合口漏需行粪便转流、1 例因直肠阴道瘘需行修补）需要再次干预。仅报告 1 例术中并发症（吻合器故障），无死亡病例。Wexner 便秘评分从术前的 19（14-24）中位数（范围）显著降低至术后 6 个月的 9（5-15）中位数（范围）（p<0.001）。仅 10 例（4%）患者复发，其中仅 3 例需要再次干预。1 年后患者满意度为 86%优，13%良，1%差。
STARR 是治疗伴有 ODS 的直肠前突的一种安全、有效、微创的技术。
