Die STARR-Operation

Purpose: A new alternative treatment of obstructed defecation syndrome (ODS) has been established with the STARR operation (stapled transanal rectal resection) today. The aim of our study was the evaluation of functional and surgical results of this method. Methods: Between December 2002 and November 2005 60 STARR operations were carried out. Two staplers were used for each transanal resection of the distal rectal ampulla, the first stapler for the resection of the anterior rectal wall, and the second for the posterior one. Results: The median follow-up was 16 (3–49) months. All operations were carried out by one senior surgeon with proctologic expertise. All full thickness specimens were examined histopathologically. Mean operation time was 36.5 minutes. There was one incomplete stapler line that could be sutured without problems; no other intraoperative complications occurred. There were two urinary tract infections, and one erosive gastritis postoperatively. A proctitis could be treated conservatively in four patients. A small anastomotic leakage was also treated conservatively. Re-operations had to be done in seven patients (one postoperative bleeding, two cases of stenosis treated with dilatation, four cases with removal of staples). Mean hospital stay was seven days. 67.4% of the patients reported a functional improvement, 32.6% not. 80.5% of the patients were more or less satisfied with the postoperative result, 19.5% were dissatisfied. In ten patients an anal incontinence has been set out after the STARR operation. Preoperative existing anal incontinence was only enhanced discretely. Conclusions: There is an additional option in the surgical treatment of ODS with the STARR operation. More than two thirds of patients demonstrated a functional improvement. Under restrictive indications STARR operation seems to be a useful option in the treatment of ODS after failure of conservative alternatives.