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Article review: Constipation and continence after transanal rectal resection
Background. Although stapled transanal rectal resection (STARR) has become an important surgical option in the treatment of obstructive defecation syndrome, objective data about parameters that predict its success or failure are not yet available.
Methods. Medical history, clinical and radiomorphological data were obtained prospectively from a multi-institutional STARR registry. Predictive factors for postoperative constipation (Cleveland Clinic Constipation Score, CCS) and incontinence (Cleveland Clinic Incontinence Score, CCIS) were identified using univariable and multivariable analysis.
Results. Data were obtained for 181 of 201 patients in the STARR registry, with completed median follow‐up of 19.4 (range 12–41) months. Although the CCS decreased significantly overall [from mean (SD) 16.3 (4.9) to 6.7 (4.1); P < 0.001], 31 patients (17.1%) complained about persisting constipation. CCIS levels remained unchanged overall, but 16 patients (8.8% ) had new‐onset faecal incontinence. Multivariable analysis revealed that rectocele (β = −0.302, P < 0.001) and intussusception (β = −0.392, P < 0.001) were independent predictors of low CCS, and intussusception (β = −0.216, P = 0.001) and enterocele (β = −0.171, P = 0.012) were independent predictors of low CCIS. In contrast, small rectal diameter (β = −0.293, P < 0.001), low squeeze pressure (β = −0.188, P = 0.005) and increased pelvic floor descent at rest (β = 0.264, P < 0.001) predicted high CCIS.
Conclusion. Factors for a favourable outcome after STARR included rectocele, intussusception and enterocele, whereas small rectal diameter, low sphincter pressure and increased pelvic floor descent were unfavourable. These findings should be integrated into the therapy algorithm for STARR.
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