Post-operative clinical, manometric, and defecographic findings in patients undergoing unsuccessful STARR operation for obstructed defecation

  • A. PicciarielloEmail author
  • V. Papagni
  • G. Martines
  • M. De Fazio
  • R. Digennaro
  • D. F. Altomare
Original Article



To evaluate the reason for failure of STARR (stapled transanal rectal resection) operation for obstructed defecation.


A retrospective study (June 2012–December 2017) was performed using a prospectively maintained database of patients who underwent STARR operation for ODS (obstructed defecation syndrome), complaining of persisting or de novo occurrence of pelvic floor dysfunctions. Postoperative St Mark’s and ODS scores were evaluated. A VAS was used to score pelvic pain. Patients’ satisfaction was estimated administering the CPGAS (clinical patient grading assessment scale) questionnaire. Objective evaluation was performed by dynamic proctography and anorectal manometry.


Ninety patients (83.3% females) operated for ODS using STARR technique were evaluated.

Median ODS score was 19 while 20 patients (22%) reported de novo fecal urgency and 4 patients a worsening of their preoperative fecal incontinence.

Dynamic proctography performed in 54/90 patients showed a significant (> 3.0 cm) rectocele in 19 patients, recto-rectal intussusception in 10 patients incomplete emptying in 24 patients. When compared with internal normal standards, anorectal manometry showed decreased rectal compliance and maximum tolerable volume in patients with urgency. Nine patients reported a persistent postoperative pelvic pain (median VAS score 6).


Failure of STARR to treat ODS, documented by persisting ODS symptoms, fecal urgency, or chronic pelvic pain, is often justified by the persistence or de novo onset of alteration of the anorectal anatomy at defecation. This occurs in about half of the patients, but in 40% of the cases who complained of incomplete emptying or incontinence, anatomical abnormalities were not recognized.


Obstructed defecation STARR Defecography Anal manometry Fecal incontinence Fecal urgency 


Authors contribution

Arcangelo Picciariello, MD: conception and design of the study, acquisition analysis and interpretation of data, writing the paper, and final approval of the version to be published

Vincenzo Papagni, MD: acquisition analysis and interpretation of the data,and final approval of the version to be published

Gennaro Martines, MD: acquisition analysis and interpretation of the data, and final approval of the version to be published

Michele De Fazio, MD: acquisition analysis and interpretation of the data, and final approval of the version to be published

Rosa Digennaro, MD: acquisition analysis and interpretation of the data, and final approval of the version to be published

Prof Donato F. Altomare, MD: aonception and design of the study, interpretation of the results, writing the paper, and final approval of the version to be published

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Diseases (CIRPAP)University “Aldo Moro” of BariBariItaly

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