Disappointing long-term outcomes after stapled trans-anal rectal resection (STARR) for obstructed defecation

Purpose: To assess both short and long-term functional outcomes and quality of life of patients treated with stapled trans-anal rectal resection (STARR) for obstructed defecation syndrome (ODS).
Methods: 46 patients with ODS, due to rectocele and/or rectal intussusceptions were treated with STARR. Data collected included demographics, OR time, pain score using visual analog scale (VAS), and complications. The study included defecographic assessment and anal manometry [Urge to defecate volume (UTDV) and maximum tolerable volume (MTV)], both were done preoperative and 1 year postoperative. Modified obstructed-defecation questionnaire (MODS), patient assessed constipation-quality of life (PAC-QOL) score and Cleveland clinic foundation (CCF) continence score were all recorded preoperative and every 6 months during follow-up.
Results: Mean age was 48.4 years. 45 patients had mild postoperative pain (VAS: 1-2). Only one male patient had severe pain (VAS: 7). Three patients developed stenosis at the staple line
6 months postoperative and were dilated manually. Follow-up period range was (18 – 48) and median follow-up period was 42 month. Recurrence rate was 6.5% after 18 months, 10.8% after
36 months and 13 % after 42 months. Significant reduction in maximal tolerable volume (MTP) and urge to defecate volume (UTDV) was recorded. Modified obstructed-defecation questionnaire (MODS) and PAC-QOL showed significant improvement after 6 months and this improvement was maintained for 18 months then rapid decline till the end of follow up period.
Conclusions: STARR is a safe surgical procedure that effectively restores anatomy and function of the anorectum in patients with ODS. This correction improves functional and QOL scores, however high rate of symptomatic recurrence and QOL score decline are expected after18 months.