Brief Article
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World J Gastroenterol. Oct 7, 2011; 17(37): 4199-4205
Published online Oct 7, 2011. doi: 10.3748/wjg.v17.i37.4199
Comparative outcome of stapled trans-anal rectal resection and macrogol in the treatment of defecation disorders
Ivano Biviano, Danilo Badiali, Laura Candeloro, Fortunée Irene Habib, Massimo Mongardini, Angelo Caviglia, Fiorella Anzini, Enrico S Corazziari
Ivano Biviano, Danilo Badiali, Laura Candeloro, Fortunée Irene Habib, Fiorella Anzini, Enrico S Corazziari, Department of Medicine and Medical Specialties, SAPIENZA, Rome University, 00161 Rome, Italy
Massimo Mongardini, Department of Surgical Sciences, Division of General Surgery L, SAPIENZA Rome University, 00161 Rome, Italy
Angelo Caviglia, Departmental Operative Unit of Colonproctology, Hospital San Camillo-Forlanini, 00161 Rome, Italy
Author contributions: Biviano I maintained the database and obtained the follow-up data; Badiali D supplied the patients, acquired the data, performed the anorectal manometry, and interpreted results; Habib FI acquired data, performed the defecography, and interpreted the results; Mongardini M and Caviglia A supplied patients and performed the stapled trans-anal rectal resection procedure; Candeloro L maintained the database and obtained follow up data; Anzini F provided technical assistance; Corazziari ES, conceived the study protocol, supplied patients, interpreted the data, and critically revised the article.
Correspondence to: Dr. Danilo Badiali, Department of Medicine and Medical Specialties, SAPIENZA, Rome University, Italy Viale del Policlinico 155, 00161 Rome, Italy.
Telephone: +39-06-49978305 Fax: +39-06-49978384
Received: December 22, 2010
Revised: March 4, 2011
Accepted: March 11, 2011
Published online: October 7, 2011

AIM: To prospectively assess the efficacy and safety of stapled trans-anal rectal resection (STARR) compared to standard conservative treatment, and whether preoperative symptoms and findings at defecography and anorectal manometry can predict the outcome of STARR.

METHODS: Thirty patients (Female, 28; age: 51 ± 9 years) with rectocele or rectal intussusception, a defecation disorder, and functional constipation were submitted for STARR. Thirty comparable patients (Female, 30; age 53 ± 13 years), who presented with symptoms of rectocele or rectal intussusception and were treated with macrogol, were assessed. Patients were interviewed with a standardized questionnaire at study enrollment and 38 ± 18 mo after the STARR procedure or during macrogol treatment. A responder was defined as an absence of the Rome III diagnostic criteria for functional constipation. Defecography and rectoanal manometry were performed before and after the STARR procedure in 16 and 12 patients, respectively.

RESULTS: After STARR, 53% of patients were responders; during conservative treatment, 75% were responders. After STARR, 30% of the patients reported the use of laxatives, 17% had intermittent anal pain, 13% had anal leakage, 13% required digital facilitation, 6% experienced defecatory urgency, 6% experienced fecal incontinence, and 6% required re-intervention. During macrogol therapy, 23% of the patients complained of abdominal bloating and 13% of borborygmi, and 3% required digital facilitation.No preoperative symptom, defecographic, or manometric finding predicted the outcome of STARR. Post-operative defecography showed a statistically significant reduction (P < 0.05) of the rectal diameter and rectocele. The post-operative anorectal manometry showed that anal pressure and rectal sensitivity were not significantly modified, and that rectal compliance was reduced (P = 0.01).

CONCLUSION: STARR is not better and is less safe than macrogol in the treatment of defecation disorders. It could be considered as an alternative therapy in patients unresponsive to macrogol.

Keywords: Constipation, Obstructed defecation, Rectocele, Rectal intussusception, Stapled trans-anal rectal resection