Functional and morphologic outcome after stapled transanal rectal resection for obstructed defecation syndrome.

ABSTRACT

BACKGROUND: Stapled transanal rectal resection is a novel surgery for obstructed defecation syndrome. Few data on the functional and morphologic outcome after the surgery have been reported. OBJECTIVE: This study aimed to evaluate the functional and morphologic outcome after stapled transanal rectal resection. DESIGN: This is a prospective study of consecutive patients undergoing transanal rectal resection. SETTING: The study was conducted at a tertiary referral hospital, Beijing, China, from May 2007 to May 2009. PARTICIPANTS: Eighty-six consecutive female patients with obstructed defecation syndrome were carefully selected. INTERVENTIONS: All patients underwent stapled transanal rectal resection. MAIN OUTCOME MEASURES: The main outcome measures were patients' symptoms, obstructed defecation syndrome score, Wexner incontinence score, anorectal manometry and defecography before and 1 year after surgery. RESULTS: The occurrence of all symptoms were significantly reduced after the procedure (P < .0001). Obstructed defecation syndrome score was decreased from 18.17 ± 4.68 preoperatively to 7.36 ± 3.52 postoperatively (P < .0001) with the Wexner incontinence score unchanged. Maximum tolerable rectal volume was significantly decreased (236.08 ± 50.00 vs 205.25 ± 29.60, P < .0001) after surgery with anal sphincter pressures unchanged. Postoperative defecography was performed in 64 patients. Rectocele disappeared in 40 of 62 patients. The depth of rectocele was reduced from 35.40 ± 4.58 mm preoperatively to 19.77 ± 9.19 mm postoperatively (P < .0001). Incomplete evacuation disappeared in 41 of 51 patients. Intussusception was completely corrected in 39 of 56 patients. The reduction of obstructed defection syndrome score was greater in patients with both rectocele and intussusception corrected than others (12.75 ± 2.24 vs 9.17 ± 3.47; P < .0001). LIMITATIONS: This study was limited owing to the lack of a control group and the medium-term results. CONCLUSIONS: Stapled transanal rectal resection is an effective procedure for obstructed defecation syndrome. The functional outcome is good with the preservation of sphincter function and continence postoperatively. The morphologic outcome confirmed its efficacy in correcting rectocele and intussusception, and correlated well with clinical improvement.