Skip to main content

Advertisement

SpringerLink
Log in

Pelvic floor function following ventral rectopexy versus STARR in the treatment of obstructed defecation

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

Obstructed defecation syndrome (ODS), most commonly found in females, can be treated by a transanal or abdominal approach with good success rate. Nevertheless, patients may experience de novo or persisting pelvic floor dysfunctions after surgery. The aim of this study was to compare the functional outcome of stapled transanal rectal resection (STARR) and ventral rectopexy (VRP) in a series of ODS patients.

Methods

Forty-nine female patients who had surgery for ODS between 2006 and 2016 were retrospectively evaluated: 28 (median age 60 years, IQR 54–69 years) had VRP and 21 (median age 58 years, IQR 51–66 years) had STARR. ODS was scored with the ODS score while the overall pelvic floor function was assessed with the three axial perineal evaluation (TAPE) score. Quality-of-life was evaluated by the patient assessment of constipation quality-of-life (PAC-Qol) questionnaire administered preoperatively and after 1 year of follow-up.

Results

The preoperative median ODS score and TAPE score were comparable in both groups. After a median follow-up of 12 months (range 12–18 months), the median ODS score was 12 (range 10–20) in the STARR group and 9 (range 3–15) in the VRP one (p = 0.02), while the median TAPE score was 70.5 (IQR 60.6–77.3) in the former and 76.8 (IQR 70.2–89.7) in the latter (p = 0.01). Postoperatively the physical domain of the PAC-QoL score had a median value of 2.74 (IQR 1.7–3.75) in the STARR group compared to 1.5 (IQR 1–2.5) in the VRP group (p = 0.03). No major complications were recorded in either group.

Conclusions

VRP and STARR can improve defecation in patients with ODS with minimal complications, but the overall pelvic wellness evaluated by the TAPE score improves significantly only after VRP, suggesting a better performance of VRP than STARR when overall pelvic floor function is concerned.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Martelli H, Devroede G, Arhan P, Duguay C (1978) Mechanisms of idiopathic constipation: outlet obstruction. Gastroenterology 75:623–631

    PubMed  CAS  Google Scholar 

  2. Shih DQ, Kwan LY (2007) All roads lead to Rome: update on Rome III criteria and new treatment options. Gastroenterol Rep 1:56–65

    PubMed  PubMed Central  Google Scholar 

  3. Tsar’kov PV, Sandrikov VA, Tulina IA et al (2012) Surgical treatment of rectocele with the use of mesh implants by the obstructive defecation syndrome. Khirurgiia (Mosk) 8:25–33

    Google Scholar 

  4. Pescatori M, Spyrou M, Pulvirenti d’Urso A (2006) A prospective evaluation of occult disorders in obstructed defecation using the ‘iceberg diagram’. Colorectal Dis 8:785–789

    Article  PubMed  CAS  Google Scholar 

  5. Altomare DF, Di Lena M, Giuratrabocchetta S et al (2014) The Three Axial Perineal Evaluation (TAPE) score: a new scoring system for comprehensive evaluation of pelvic floor function. Colorectal Dis 16:459–468

    Article  PubMed  CAS  Google Scholar 

  6. Altomare DF (2010) ODS score and obstructed defecation. Dis Colon Rectum 53:363

    Article  PubMed  Google Scholar 

  7. Karlbom U, Nilsson S, Pahlman L, Graf W (1999) Defecographic study of rectal evacuation in constipated patients and control subjects. Radiology 210:103–108

    Article  PubMed  CAS  Google Scholar 

  8. Boccasanta P, Venturi M, Stuto A et al (2004) Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial. Dis Colon Rectum 47:1285–1296

    Article  PubMed  Google Scholar 

  9. D’Hoore A, Cadoni R, Penninckx F (2004) Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg 91:1500–1505

    Article  PubMed  Google Scholar 

  10. Goede AC, Glancy D, Carter H, Mills A, Mabey K, Dixon AR (2011) Medium-term results of stapled transanal rectal resection (STARR) for obstructed defecation and symptomatic rectal-anal intussusception. Colorectal Dis 13:1052–1057

    Article  PubMed  CAS  Google Scholar 

  11. Wijffels NA, Jones OM, Cunningham C, Bemelman WA, Lindsey I (2013) What are the symptoms of internal rectal prolapse? Colorectal Dis 15:368–373

    Article  PubMed  CAS  Google Scholar 

  12. Vaizey CJ, Carapeti E, Cahill JA, Kamm MA (1999) Prospective comparison of faecal incontinence grading systems. Gut 44:77–80

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Marquis P, De La Loge C, Dubois D, McDermott A, Chassany O (2005) Development and validation of the Patient Assessment of Constipation Quality of Life questionnaire. Scand J Gastroenterol 40:540–551

    Article  PubMed  Google Scholar 

  14. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  15. Travaglio E, Lemma M, Cuccia F et al (2014) Prevalence of constipation in a tertiary referral Italian Colorectal Unit. Ann Ital Chir 85:287–291

    PubMed  Google Scholar 

  16. Van Geluwe B, Stuto A, Da Pozzo F et al (2014) Relief of obstructed defecation syndrome after stapled transanal rectal resection (STARR): a meta-analysis. Acta Chir Belg 114:189–197

    Article  PubMed  Google Scholar 

  17. Madbouly KM, Abbas KS, Hussein AM (2010) Disappointing long-term outcomes after stapled transanal rectal resection for obstructed defecation. World J Surg 34:2191–2196

    Article  PubMed  Google Scholar 

  18. Kohler K, Stelzner S, Hellmich G, Lehmann D, Jackisch T, Fankhanel B, Witzigmann H (2012) Results in the long-term course after stapled transanal rectal resection (STARR). Langenbecks Arch Surg 397:771–778

    Article  PubMed  Google Scholar 

  19. Gagliardi G, Pescatori M, Altomare DF et al (2008) Results, outcome predictors, and complications after stapled transanal rectal resection for obstructed defecation. Dis Colon Rectum 51:186–195

    Article  PubMed  Google Scholar 

  20. Naldini G (2011) Serious unconventional complications of surgery with stapler for haemorrhoidal prolapse and obstructed defaecation because of rectocoele and rectal intussusception. Colorectal Dis 13:323–327

    Article  PubMed  CAS  Google Scholar 

  21. De Nardi P, Bottini C, Faticanti Scucchi L, Palazzi A, Pescatori M (2007) Proctalgia in a patient with staples retained in the puborectalis muscle after STARR operation. Tech Coloproctol 11:353–356

    Article  PubMed  Google Scholar 

  22. Kim M, Meurette G, Lehur PA (2016) Obstructed defecation: STARR or rectopexy? Colorectal Dis 18:438–439

    Article  PubMed  Google Scholar 

  23. Tsunoda A, Ohta T, Kiyasu Y, Kusanagi H (2015) Laparoscopic ventral rectopexy for rectoanal intussusception: postoperative evaluation with proctography. Dis Colon Rectum 58:449–456

    Article  PubMed  Google Scholar 

  24. Borie F, Bigourdan JM, Pissas MH, Guillon F (2014) Laparoscopic ventral rectopexy for the treatment of outlet obstruction associated with recto-anal intussusception and rectocele: a valid alternative to STARR procedure in patients with anal sphincter weakness. Clin Res Hepatol Gastroenterol 38:528–534

    Article  PubMed  Google Scholar 

  25. Grassi R, Romano S, Micera O, Fioroni C, Boller B (2005) Radiographic findings of post-operative double stapled trans anal rectal resection (STARR) in patient with obstructed defecation syndrome (ODS). Eur J Radiol 53:410–416

    Article  PubMed  Google Scholar 

  26. Adeyemo D (2014) Mesh fistulation into the rectum after laparoscopic ventral mesh rectopexy. Int J Surg Case Rep 5(3):152–154

    Article  PubMed  Google Scholar 

  27. Wahed S, Ahmad M, Mohiuddin K, Katory M, Mercer-Jones M (2012) Short-term results for laparoscopic ventral rectopexy using biological mesh for pelvic organ prolapse. Colorectal Dis 14:1242–1247

    Article  PubMed  CAS  Google Scholar 

  28. Franceschilli L, Varvaras D, Capuano I et al (2015) Laparoscopic ventral rectopexy using biologic mesh for the treatment of obstructed defaecation syndrome and/or faecal incontinence in patients with internal rectal prolapse: a critical appraisal of the first 100 cases. Tech Coloproctol 19:209–219

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Author notes

  1. D. F. Altomare and A. Picciariello have contributed equally to this work.

Authors and Affiliations

  1. Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Disease (CIRPAP), University Aldo Moro of Bari, Piazza G Cesare 11, 70124, Bari, Italy

    D. F. Altomare, A. Picciariello, R. Memeo, R. Digennaro, N. Chetta & M. De Fazio

  2. Nuclear Medicine Unit, D.I.M. University Aldo Moro of Bari, Bari, Italy

    M. Fanelli

Authors
  1. D. F. Altomare
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Picciariello
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Memeo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Fanelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Digennaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. N. Chetta
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. De Fazio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. F. Altomare.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This study was approved by the independent Ethics Committee of the Azienda Ospedaliero-Universitazla Policlinico BARI.

Informed consent

All patients received and agreed to the patient information sheet and informed consent for the study and procedure.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Altomare, D.F., Picciariello, A., Memeo, R. et al. Pelvic floor function following ventral rectopexy versus STARR in the treatment of obstructed defecation. Tech Coloproctol 22, 289–294 (2018). https://doi.org/10.1007/s10151-018-1776-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-018-1776-3

Keywords

Search

Navigation