1 / 24

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.

Rita
Download Presentation

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

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related