Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception

Table 1 Longo’s ODS score system

ODS-score (0-40)
Defecation frequency	1-2 def/1-2 d	0	2 def /wk or 3 def or attempts/d	1	1 def/wk or 4 def or attempts/d	2	< 1 def/wk or > 4 def or attempts/d			3
Straining
Intensity	No, light	0	Moderate	1	Intensive	2
Extension			Short time	1	Prolonged	2
Sensation of inco-mplete evacuation	Never	0	≤ 1 time/wk	1	2 times/wk	2	> 2 times/wk			3
Recto/perineal pain/discomfort	Never	0	≤ 1 time/wk	1	2 times/wk	2	> 2 times/wk			3
Activity reduction per week	Never	0	< 25% of activity	2	25%-50% of activity	4	> 50% of activity			6
Laxatives	Never	0	< 25% of def	1	25%-50% of def	3	> 50% of def	5	Always	7
Enemas		0		1		3		5		7
Digitation		0		1		3		5		7

ODS: Obstructed defecation syndrome.

Table 2 Symptom severity score

Symptoms	None	Very short time	Some time	Most of the time	All of the time
Need laxatives/enemas	0	1	2	3	4
Unsuccessful attempts to open bowels	0	1	2	3	4
Low frequency of bowel movements	0	1	2	3	4
Pain on opening bowels	0	1	2	3	4
Bleeding on bowel opening	0	1	2	3	4
Incomplete bowel opening	0	1	2	3	4
Increased time or straining to open bowels	0	1	2	3	4
Incontinence/soiling	0	1	2	3	4
Difficulty to withstand urge to open bowels	0	1	2	3	4

Table 3 Previous anorectal or gynecologic surgery in patients undergoing STARR n (%)

Operation	Patients
Milligan-Morgan hemorrhoidectomy	11 (22)
Fistulectomy	1 (2)
Fistulotomy	1 (2)
Closed lateral subcutaneous sphincterotomy	1 (2)
Stapled hemorrhoidopexy	1 (2)
Episiotomy	13 (26)
Hysterectomy	9 (18)
Abdominal delivery	7 (14)

STARR: Stapled transanal rectal resection.

Table 4 Presenting symptoms and early complications in patients undergoing STARR n (%)

Symptoms	Incidence	Early complications	Incidence
Excessive straining	43 (86)	Defecatory urgency	21 (42)
Feeling of incomplete evacuation	42 (84)	Bleeding3	4 (8)
Rectal bleeding1	32 (64)	Incontinence to flatus	3 (6)
Rectoperineal discomfort	23 (46)	Acute urinary retention	2 (4)
Abdominal distension	21 (42)	Severe pain	2 (4)
Abdominal pain	20 (40)	Anal fissure	1 (2)
Feeling of rectal obstruction	16 (32)	Rectovaginal fistula	0
Laxatives2	34 (68)	Perianal sepsis	0
Enema	20 (40)	Staple line dehiscence	0
Rectal or vaginal digitation	17 (34)	Mortality	0

¹> 1 episode/wk;

²> 2 episodes/mo;

³No treatment was required.

Table 5 Intermediate complications in patients undergoing STARR n (%)

Symptoms	3 mo	6 mo	12 mo
Defecatory urgency	5 (10)	3 (6)	1 (2)
Incontinence to flatus	1 (2)	1 (2)	1 (2)
Incontinence to feces	1 (2)	1 (2)	1 (2)
Chronic pain	2 (4)	1 (2)	1 (2)
Constipation	4 (8)	5 (10)	5 (10)
Rectal stenosis	0	0	0
Rectal diverticulum	0	0	0