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Initial Experience With Tst STARR Plus to Treat Obstructed Defecation Syndrome
Luana Franceschilli, Delia Lacapra, Ilaria Capuano, Federica Giorgi, Vito Maria Stolfi, Achille Lucio Gaspari, Pierpaolo Sileri*
University of Rome Tor Vergata, Rome, Italy
OBJECTIVE: Obstructed defecation syndrome (ODS) due to internal intussusception and rectocele is a common disease, and various transanal surgical techniques have been proposed. The aim of this work was to assess the efficacy of STARR to treat ODS performed by a new dedicated device, TST STARR Plus.
METHODS:
All patients affected by obstructed defecation syndrome (ODS) with rectocele and/or rectal intussusception that underwent stapled transanal resection with TST STARR plus were included in the present study. All patients underwent preoperative assessment: clinical evaluation (Wexner constipation scoring system, Faecal incontinence Severity index score), proctoscopy and defecography. A WCS ≥5, and a FISI ≥10 were considered clinically relevant.Haemostatic stitches for bleeding/reinforcement of the suture line, specimen volume, operative time, hospital stay and perioperative complications were recorded.
RESULTS:
From January 2014 to July 2014, eleven patients (9 females, 2 men) were enrolled in the study. The mean duration of the procedure was 45 minutes. The mean resected volume of the specimen was 19 cc (range 13-25), the mean hospital stay was 2 days. In all patients additional stitches on the suture line were needed. None suture line dehiscence was reported both intraoperatively and postoperatively. Urgency after 30 days was reported in 3 out eleven (16%) patients and persisted in one patients by the third month of FU (9%). The Wexner constipation score (WCS) postoperatively fell from 7.7 to 5.1 at 3 months of FU(p<2.1.) and from 2.5 to 2.2 (range 1-6) at 6 months in 6 out 11 patients. No major complication occurred. Patients' satisfaction was measured 30 days after surgery with a four-item scale, resulting excellent in 44%, good in 44%, and sufficient in 11% of patients.
CONCLUSIONS:
According to our preliminary results, the new device (TST STARR plus) seems to be safe and effective for the treatment of obstructed defecation syndrome.
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