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The Stapled Trans-Anal Rectocele Resection (S T A R R) Technique and Results. Stefan Farke Department of Surgery Schlosspark-Klinik, Berlin, Germany. O D S O bstructed D efecation S yndrome S T A R R S tapled T rans A nal R ectocele R esection. Obstructed Defecation.

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the stapled trans anal rectocele resection s t a r r technique and results

The Stapled Trans-Anal Rectocele Resection(S T A R R)Technique and Results

Stefan Farke

Department of Surgery

Schlosspark-Klinik, Berlin, Germany

slide2

O D S

Obstructed Defecation Syndrome

S T A R R

Stapled TransAnal Rectocele Resection

s t a r r
Principle theory:

Reconstruction of normal anatomy

Resection of the distal rectum

Resection of rectocele

Resection of rectal wall prolaps

Elevation of the pelvic floor

S.T.A.R.R
s t a r r6
S.T.A.R.R.
  • Operation in lithotomy position
  • General- or Spinal-Anaesthesia
  • PPH 01 Set, metal spatula
s t a r r7
S.T.A.R.R.
  • Insertion of the transparent proctoscope and fixation with sutures following gentle dilatation
s t a r r8
S.T.A.R.R.
  • Full thickness stitches of the rectal wall, three stitches at the edge of the prolaps or several semi-circular sutures above the dentate line
  • Resection of the anterior rectal wall with the first stapler, protection of the posterior wall
  • Careful examination of the posterior vaginal wall
s t a r r11
S T A R R
  • Resection of the posterior wall in the same manner
  • Suturing of the overlaps of the stapling lines and control of hemostasis
results
Results
  • First results very promising
  • No longterm results
  • Only few studies
  • Mainly single center experiences
results s t a r r
Results S T A R R
  • 14 patients, mean follow up 19 month (1-30)
  • 8 patients very satisfied
  • 6 patients satisfied
  • Significant reduction of defecation-scores

A. Ommer, K. Albrecht, F. Wenger, M.K. Walz: Stapled transanal rectal resection (STARR): a new option in the treatment of obstructive defecation syndrome, Langenbecks Arch Surg (2006) 391: 32 - 37

results s t a r r18
Results S T A R R
  • 60 patients, mean follow up 16 month (3-49)

M. Sielaff, R. Scherer, H. Gögler, S. Farke: Die STARR-Operation Erfahrungen bei 60 Patienten, coloproctology 28 (2006), 4: 217-23

results19
Results

Author year n FU (Mo.) success

Boccasanta 04 25 20 88 %

Sielaff, Farke 04 60 16 68 %

Ommer 06 14 19 100 %

Boccasanta 07 34 8 94 %

Guarnieri 08 20 85 %

Slim 08 100 85 %

Gagliardi 08 123 17 65 %

german s t a r r register
German S T A R R Register
  • Standardized documentation
  • Evaluation of safety and efficacy of STARR procedure in patients with ODS
  • Register startet 15.05.2006, first evaluation 2007
  • Results:
    • n = 122
    • 85,2 % without complications
    • No mortality
clinical symptoms
Clinical symptoms
  • Severe symptomatic outlet constipation
  • „digitizing“
  • „overflow incontinence“
  • Failed improvement by enema / laxatives
  • soiling
  • pain
slide22

rest

squeeze

103°

defecation

Defecography

s t a r r success
S T A R R - Success

Indications

  • Failure of conservative therapy in obstructed defecation
  • Rectocele, DPS, Intussusception
  • Exclusion of slow transit constipation
  • Exclusion of spastic outlet
conclusion
Conclusion
  • The STARR-Operation is a new procedure with promising first results
  • It is a new approach to improve function in obstructed defecation
  • The indication is most importment for a good result
  • There are no long term results