Hvilke virkninger har Stapled Transanal Rectal Resection (STARR) på Obstructed Defecation Syndrome (ODS), assosiert med rektocele og intussuscepsjon?

Abstract

ABSTRACT

Title: Efficacy of Stapled Transanal Rectal Resection (STARR) for Obstructed defecation Syndrome (ODS), associated with rectocele and intussusception.

Background: Intussusception and rectocele are frequent clinical findings in patients with obstructed defecation syndrome (ODS). However, there is still no evidence whether stapled transanal rectal resection (STARR) provides a safe and effective surgical option.

Purpose: The purpose with this literature study was to evaluate the efficacy of stapled transanal rectal resection (STARR) for obstructed defecation syndrome (ODS), assosiated with rectocele and intussusception.

Method: Literature study. The search was done in august 2011 in the following databases: Chochrane Library, Pubmed and Embase.

Results: This literature study is based on 10 studies with interventional prospective cohort-design. The studies showed a significant improwement in most of the functional outcomes, and a significant improwement in the outcomes for quality of life and patient satisfaction. For incontinence, the results were not clear. There were no or few major postoperative complications such as pelvic abscess, anastomotic leak, or rectovaginal fistula. Generally, minor postoperative complications were frequent, fecal urgency the most common. However, fecal urgency showed a decrease with time.

Conclusion: The studies indicate that the efficacy of stapled transanal rectal resection (STARR) for obstructed defecation syndrome (ODS) are safe and effective, but conclusions are limited due to limited evidence. The reasons are that most of the studies are small with short follow-up. The design of the studies is not adequate, therefore it is a high risk for systematic bias. Randomised clinical trials are needed to evaluate STARR against other treatment options.

Key words: Stapled transanal rectal resection, obstructed defecation syndrome, rectocele, intussusception, fecal incontinence, fecal urgency, constipation.