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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. 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

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  1. The Stapled Trans-Anal Rectocele Resection(S T A R R)Technique and Results Stefan Farke Department of Surgery Schlosspark-Klinik, Berlin, Germany

  2. O D S Obstructed Defecation Syndrome S T A R R Stapled TransAnal Rectocele Resection

  3. Obstructed Defecation

  4. 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

  5. S.T.A.R.R. • Operation in lithotomy position • General- or Spinal-Anaesthesia • PPH 01 Set, metal spatula

  6. S.T.A.R.R. • Insertion of the transparent proctoscope and fixation with sutures following gentle dilatation

  7. 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

  8. S T A R R

  9. 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

  10. S T A R R

  11. Results • First results very promising • No longterm results • Only few studies • Mainly single center experiences

  12. 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

  13. S T A R R – Results

  14. 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

  15. 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 %

  16. 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

  17. Clinical symptoms • Severe symptomatic outlet constipation • „digitizing“ • „overflow incontinence“ • Failed improvement by enema / laxatives • soiling • pain

  18. rest squeeze 103° defecation Defecography

  19. 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

  20. 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

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