Stapled transanal rectal resection with contour transtar for obstructed defecation syndrome: lessons learned after more than 3 years of single-center activity.

BACKGROUND: Obstructed defecation syndrome (ODS) is a widespread and disabling disease. OBJECTIVE: We want to evaluate the safety and efficacy of Stapled Transanal Rectal Resection (STARR) performed with a new dedicated device in the treatment of ODS. DESIGN: A retrospective review of 187 STARR performed from June 2007 to February 2011 was conducted. SETTINGS: The whole study was conducted at a University Hospital. PATIENTS: All the patients with symptomatic ODS and the presence of a rectocele and/or a recto-rectal or recto-anal intussusception, in the absence of sphincter contractile deficiency, were included in the treatment protocol. INTERVENTIONS: All procedures were performed using Contur Transtar device. We analyze the functional results of this technique and the incidence and features of the surgical and functional complications and how you can prevent or treat them. MAIN OUTCOME MEASURES: Constipation was graded using the Agachan-Wexner constipation score; use of aids to defecate and patient satisfaction were assessed preoperatively and 6 months after surgery. Intraoperative and postoperative complications were also investigated. RESULTS: The constipation intensity was statistically reduced from the preoperative mean value of 15.8 (± 4.9) to 5.2 (± 3.9) at 6 months after surgery (p<0.0001). Of the 151 (80.3%) patients who took laxatives and 49 (26.2%) who used enemas before treatment, only 25 (13.2 %; p<0.0001) and 7 (3.7%; p