STARR with CONTOUR® TRANSTAR™ device for obstructed defecation syndrome: one-year real-world outcomes of the European TRANSTAR registry

Abstract

PurposeStapled transanal rectal resection (STARR) in patients with obstructive defecation syndrome (ODS) is limited by the capacity of the circular stapler used. This prospective cohort study was conducted to assess real-world clinical outcomes of STARR with the new CONTOUR® TRANSTAR™ device, shortly named TRANSTAR, at 12 months postoperatively.MethodsFrom January 2009 to January 2011, consecutive patients who underwent TRANSTAR in 22 European colorectal centers were enrolled in the study. Functional outcomes and quality of life were assessed by the changes in a number of scoring systems (Knowles-Eccersley-Scott-Symptom (KESS) score, ODS score, St. Mark’s score, Euro Quality of Life-5 Dimension (EQ-5D) score, and Patient Assessment of Constipation—Quality of Life (PAC-QoL) score), at 12 months as compared to baseline. All complications were recorded and analyzed.ResultsA total of 100 patients (98 % female), mean age 60 years, were entered in the study. Statistically significant improvements were seen in the KESS (median 18 vs. 6; p < 0.01), ODS (median 15 vs. 4; p < 0.01), and PAC-Qol scores (median 2.10 vs. 0.86; p < 0.01). St. Mark’s and EQ-5D scores improved nonsignificantly. Complications were reported in 11 % of patients, including bleeding (5 %), staple line complications (3 %), urinary retention (2 %), and persistent pain (1 %). No major complications or mortality occurred.ConclusionTRANSTAR facilitated a tailored, real circumferential full-thickness rectal resection, leading to improved patient functional and quality of life outcomes at 12 months postoperatively. It represents a safe and effective treatment for ODS in local clinical practice, although the sustainability of real-world results needs to be proven in the long-term follow-up.

Multicentre observational study of outcomes after drainage of acute perianal abscess

“…Preoperative or baseline scores were not taken, so conclusions cannot be drawn about the effect of either perianal abscess or the incision and drainage on quality of life. EQ‐5D™ is a validated assessment tool for assessing quality of life in surgical trials. Overall health scores inversely mirrored the pain scores during pack changes, with the most evident improvement occurring steadily throughout the first 7 days.…”

Different characteristics of circular staplers make the difference in anastomotic tensile strength

“…Surgical complications, as anastomotic leak, can be very important leading to prolonged hospital stay, increased morbidity, mortality and medical costs (Mirnezami et al, 2011;Longo, 1998;Boccasanta et al, 2004;Ribaric et al, 2014;Naldini et al, 2014;Naldini, 2011). Although those surgical devices are widespread in different surgical fields, there are a few published papers about their technical features.…”

Descending perineum syndrome: new perspectives

“…Fecal incontinence and obstructed defecation are significantly reduced. Only one randomized trial compared Delorme to STARR: The overall incidence of postoperative complications was low and similar between the two groups of patients, and a significant improvement in symptoms was obtained with both techniques [45].…”

“…However, there are no randomized trials that actually validate this technique. Resective surgery (stapled transanal rectal resection (STARR)-TRANSTAR [45], Delorme operation [46]) is used for rectoanal intussusception and rectocele. Fecal incontinence and obstructed defecation are significantly reduced.…”