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Troubleshooting the Starr Procedure

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Reconstructive Surgery of the Rectum, Anus and Perineum

Abstract

In patients presenting with obstructed defecation syndrome, it is recognized that specific morphological abnormalities including rectocele, rectoanal intussusception, rectal internal mucosal prolapse, and enterocele represent the tip of an “iceberg syndrome.” In these patients, other mitigating factors which may cause significant functional overlay, including paradoxical puborectalis syndrome, irritable bowel syndrome, and central psychological problems, define patients who functionally fare badly after stapled endoanal procedures. In this regard, it is recognized that more than 90% of patients presenting with obstructed defecation have multiple pelvic floor and perineal soft-tissue anomalies that may not respond to simple rectocele repair. Equally, the reporting of stapled procedures in these patients in whom there is controversy concerning the selective indications and contraindications for such procedures is mixed, and there seems to be a dual dialogue: some have reported exceptional postoperative outcomes and others have reported serious postoperative neosymptomatology, which is often recalcitrant to further surgical intervention. The medicolegal imperative is on coloproctologists to outline for patients the adverse events that may occur, most notably, urgency, incontinence, and recurrent or residual defecation difficulty.

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Authors and Affiliations

  1. Department of Coloproctology Unit, Ars Medica Hospital and La Sapienza University, Rome, Italy

    Mario Pescatori M.D., FRCS, EBSQ

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  1. Mario Pescatori M.D., FRCS, EBSQ
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Correspondence to Mario Pescatori M.D., FRCS, EBSQ .

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Editors and Affiliations

  1. Tamworth Rural Referral Hospital, Dean Street, Tamworth, 2340, New South Wales, Australia

    Andrew P. Zbar

  2. Delware Street 420, Minneapolis, 55455, Minnesota, USA

    Robert D. Madoff

  3. , Dept. Colorectal Surgery, Cleveland Clinic, Florida, Cleveland Clinic Blvd. 2950, Weston, 33331, Florida, USA

    Steven Wexner

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Pescatori, M. (2013). Troubleshooting the Starr Procedure. In: Zbar, A., Madoff, R., Wexner, S. (eds) Reconstructive Surgery of the Rectum, Anus and Perineum. Springer, London. https://doi.org/10.1007/978-1-84882-413-3_27

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  • DOI: https://doi.org/10.1007/978-1-84882-413-3_27

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  • Print ISBN: 978-1-84882-412-6

  • Online ISBN: 978-1-84882-413-3

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