Stapled Transanal Rectal Resection (STARR) for Rectocele

Patients with obstructed defecation complain of an inability to initiate rectal emptying, incomplete evacuation, pelvic pressure or excessive straining at stool. The pathophysiologic features of obstructed defecation include an increased anterior-posterior diameter of the rectum, decreased rectal compliance and an increased sensory threshold volume. Recently, there has been interest in the transanal resection of the rectum for obstructed defecation with the developement of endoanal staplers and techniques specifically for these purpose. Stapled transanal rectal resection (STARR), in the only large series reported, decreased the anterior-posterior diameter of the rectum, restored rectal compliance and decreased the rectal sensory threshold with an associated improvement in incomplete evacuation in 81.1%, digital assistance to defecate in 83.4%, pelvic pain in 43.3%, and the need for laxatives 43.3% of patients. Risks of the procedure included stenosis in 3.3%, urgency in 1.1% and incontinence of flatus in 1.1% of patients. These data suggest that the STARR procedure is an effective management option for obstructed defecation with an acceptable risk of complications.