Beyond stapled transanal rectal resection vs ventral rectopexy dichotomy: Toward a phenotype-guided surgical paradigm for obstructed defecation syndrome

Table 1 Comparative clinical outcomes between stapled transanal rectal resection and ventral rectopexy[5,6,18,43-48]

Outcome	STARR	VR	Ref.
Symptomatic recurrence (5-10 years)	20%-40% (up to about 40% at 10 years)	< 10% (about 8%-10% at 10 years)	Schiano di Visconte[5]; Mandovra et al[43]; Barra et al[44]
Symptom improvement at 12 months	70%-90% (approximately 85% in one series)	70%-90% (durable relief)	Schiano di Visconte[5]; Mandovra et al[43]; Mäkelä-Kaikkonen et al[45]
Anatomical recurrence	Approximately 20%-38% (rectocele/intussusception)	< 5%-8%	Mandovra et al[43]; Barra et al[44]
Surgical re-intervention rate	Up to about 20%-25%	< 10%	Mäkelä-Kaikkonen et al[45]; Gagliardi et al[46]
Quality-of-life improvement	Improves initially but declines at long-term follow-up	Stable/sustained improvement	Mandovra et al[43]; Mäkelä-Kaikkonen et al[45]
Procedure-specific complications	Urgency, pain/tenesmus (approximately 20%); rare anastomotic dehiscence or fistula	Mesh-related complications about 1%-2% (erosion about 0.9%); rare mesh detachment	Hess et al[47]; Ripamonti et al[18]
Patient satisfaction	About 70%-75% overall long-term satisfaction; about 20%-35% “very satisfied” at 10 years	About 70%-85% “high satisfaction” at 2 years	Mandovra et al[43]; Mäkelä-Kaikkonen et al[45]; Schiano di Visconte et al[6]
Mean operative time	Approximately 40 minutes	Approximately 115 minutes	Mandovra et al[43]; Mandovra et al[48]
Hospital stay (days)	Approximately 2.1 days	Approximately 3.3 days	Mandovra et al[43]; Mandovra et al[48]

Reported ranges reflect variability within cohorts and follow-up periods. VR: Ventral rectopexy; STARR: Stapled transanal rectal resection.