1. Stefan Farke Department of Surgery Schlosspark-Klinik, Berlin, Germany
The Stapled Trans-Anal Rectocele Resection (S T A R R) Technique and Results
Stefan Farke
Department of Surgery
Schlosspark-Klinik, Berlin, Germany

2. Obstructed Defecation Syndrome Stapled TransAnal Rectocele Resection
O D S
Obstructed Defecation Syndrome
S T A R R
Stapled TransAnal Rectocele Resection

3. Obstructed Defecation

4. S.T.A.R.R
Principle theory:
Reconstruction of normal anatomy
Resection of the distal rectum
Resection of rectocele
Resection of rectal wall prolaps
Elevation of the pelvic floor

6. S.T.A.R.R.
Operation in lithotomy position
General- or Spinal-Anaesthesia
PPH 01 Set, metal spatula

7. S.T.A.R.R.
Insertion of the transparent proctoscope and fixation with sutures following gentle dilatation

8. S.T.A.R.R.
Full thickness stitches of the rectal wall, three stitches at the edge of the prolaps or several semi-circular sutures above the dentate line
Resection of the anterior rectal wall with the first stapler, protection of the posterior wall
Careful examination of the posterior vaginal wall

10. S T A R R

11. S T A R R
Resection of the posterior wall in the same manner
Suturing of the overlaps of the stapling lines and control of hemostasis

13. S T A R R

15. Results
First results very promising
No longterm results
Only few studies
Mainly single center experiences

16. 14 patients, mean follow up 19 month (1-30) 8 patients very satisfied
Results S T A R R
14 patients, mean follow up 19 month (1-30)
8 patients very satisfied
6 patients satisfied
Significant reduction of defecation-scores
A. Ommer, K. Albrecht, F. Wenger, M.K. Walz: Stapled transanal rectal resection (STARR): a new option in the treatment of obstructive defecation syndrome, Langenbecks Arch Surg (2006) 391:

17. S T A R R – Results Disorders Symptoms n No complaints 8
Distinct improvement
No digital evacuation no squeezing no rectal tenesmus 6
Slight improvement
No digital evacuation severe squeezing rectal tenesmus laxatives
No improvement 1

18. 60 patients, mean follow up 16 month (3-49)
Results S T A R R
60 patients, mean follow up 16 month (3-49)
M. Sielaff, R. Scherer, H. Gögler, S. Farke: Die STARR-Operation Erfahrungen bei 60 Patienten, coloproctology 28 (2006), 4:

19. Results
Author year n FU (Mo.) success
Boccasanta %
Sielaff, Farke %
Ommer %
Boccasanta %
Guarnieri %
Slim %
Gagliardi %

20. Standardized documentation
German S T A R R Register
Standardized documentation
Evaluation of safety and efficacy of STARR procedure in patients with ODS
Register startet , first evaluation 2007
Results:
n = 122
85,2 % without complications
No mortality

21. Clinical symptoms
Severe symptomatic outlet constipation
„digitizing“
„overflow incontinence“
Failed improvement by enema / laxatives
soiling
pain

22. rest
squeeze
103°
defecation
Defecography

23. S T A R R - Success
Indications
Failure of conservative therapy in obstructed defecation
Rectocele, DPS, Intussusception
Exclusion of slow transit constipation
Exclusion of spastic outlet

24. Conclusion
The STARR-Operation is a new procedure with promising first results
It is a new approach to improve function in obstructed defecation
The indication is most importment for a good result
There are no long term results