Clinical outcomes of stapled transanal rectal resection (STARR) for obstructed defecation syndrome: Is STARR really a star on long-term follow-up?

Background: Obstructive defecation syndrome (ODS) is a common and poorly understood cause of constipation. Stapled transanal rectal resection (STARR) is one of the surgical options for ODS. Objectives: This study evaluates short-term and long-term functional outcomes following STARR for ODS patients and predictive factors determining the outcome of the surgery. Design: Retrospective analysis of prospectively collected data. Setting: This study was conducted in the colorectal unit of a tertiary hospital in Mumbai, India. Patients and Methods: Patients who underwent STARR surgery for ODS from January 2009 to January 2013 were evaluated. Patients were periodically followed up for 5 years. Main Outcome Measures: Longo scores and patient satisfaction were periodically evaluated in the 5-year follow-up. Sample Size: 204 patients. Results: 204 patients (M:F = 133:71, mean age 54.2 years) were evaluated. The mean preoperative Longo score was 23.2 ± 4.1. The mean operative time was 40 min and the median hospital stay was 2.1 days. On follow-up at 3 months symptoms improved in 92% patients, at 12 months symptoms persisted or recurred in 15% patients. Mean Longo scores at 12 months, 3 years, and 5 years follow-up was 7.14, 10.25, and 16.41 respectively. Patient satisfaction rate showed a declining trend in relation to time. ODS recurrence was observed in 41 (20%) patients and 78 (38%) patients at the end of 3 years and 5 years, respectively. Conclusions: STARR for ODS is a safe surgical procedure with minimal complications and good short-term functional results but fails in maintaining long-term efficacy of its results. Proper patient selection is extremely important for good functional outcomes. Limitations: Single-center study of retrospective nature with limited sample size. Conflict of Interest: None.