Short- and mid-term functional outcomes of STARR procedure in obstructed defecation syndrome.

Abstract

Background: To assess the efficacy of the stapled transanal rectal resection (STARR) procedure in treating obstructed defecation syndrome (ODS) in patients with rectocele and rectoanal intussusception grade II-III, focusing on symptom resolution, functional improvement, and pain reduction.

Methods: This prospective study included patients undergoing STARR for ODS. Preoperative parameters such as anal pain, smearing, itching, bleeding, and obstructed defecation symptoms were assessed using standardized questionnaires (Wexner and Altomare). Functional outcomes, including constipation, incontinence, and obstruction, were evaluated at baseline and at 1, 3, and 6 months postoperatively. Pain levels were categorized into mild (0-3), moderate (4-7), and severe (8-10). Primary endpoints included functional improvement, pain reduction, and resolution of anal symptoms. Secondary endpoints included complication rates, hospital stay duration, and patient satisfaction. Statistical analysis included paired t-tests and one-way repeated measures ANOVA.

Results: Significant improvements were observed postoperatively. Anal smearing (35%) resolved by 3 months, while anal itching (42.5%) and bleeding (75%) significantly declined, stabilizing by 6 months. Severe pain (17.5%) was noted during hospitalization but fully resolved within 1 month, with 97.5% reporting only mild pain at 6 months. Patient satisfaction was 85%. Complication rates were low (7.5% Clavien-Dindo grade I/IIIa), and no reoperations were required.

Conclusions: STARR effectively improves functional outcomes and alleviates ODS symptoms, including pain, smearing, itching, and bleeding. Low complication rates and high patient satisfaction support its use as a viable surgical option, though long-term follow-up is warranted.