STARR or Stapled Trans-Anal Rectal Resection is the surgical treatment performed to treat the obstructed defecation syndrome or ODS. It is associated rectal intussusception and rectocele. The syndrome makes the patient to strain at stool. It gives the feeling of incomplete evacuation and need of self-digitate. The syndrome is usually occurred for the middle and elder aged women.
ODS (Obstructed Defecation Syndrome)
ODS is usually caused from the deformities of the rectum structure that will result in the chronic constipation. It affects the quality life for many of the patients.
- Rectal pain
- Unsuccessful evacuation attempts
- Incomplete feel of evacuation attempts
- Enema dependency
- Pelvic pressure
- Inability to empty the rectum
The disorder and symptoms are usually caused from the defecation disorders.
Diagnosis is done for the STARR in such a way that the tests are performed to rule out the slow transit constipation, proximal cancer, anismus or irritable bowel syndrome. The diagnosis considers the parameters like excessive straining, abdominal pain, abdominal discomfort, vaginal-anal-perineal digitations
Need for the STARR (Stapled Transanal Rectal Resection) Surgery
When patients are suffered from the STARR and when the diagnosis facts that the cause is the obstructed defaecation syndrome, the initial treatment recommended will be dietary modification along with pelvic floor retraining. Some of the patients get benefited from the improvement of the appropriate and suitable diet and also from bifedback therapy. When these conservative treatments are found to be not beneficial, then the STARR procedure will be preferred and considered to be performed.
Selection of the Candidate
The appropriateness of the surgery is selected for the candidates, by a team of the medical professionals, including urologist or urogynaecologist and colorectal surgeon. Usually, patients, who have structural abnormalities and resultantly the conservative treatments failure, are the suitable patients.
Before the Procedure
The patients, who have to undergo the STARR procedure, are prepared with prophylactic antibiotics and also received bowel preparation.
STARR (Stapled Transanal Rectal Resection) Surgery
The patient is given either general anesthesia or spinal anesthesia. Then anal dilator that looks circular is inserted into the anal canal. It is then secured with the sutures for the skin. Rectal walls are resected for its redundant parts. Initially anterior redundant parts resection is done first, followed by posterior rectal wall resection. Traction sutures are then introduced in order to aid clear visualization through anoscope. It is inserted above the junction of the anorect. The redundant rectal wall is prolapsed into the stapler anvil. Then it is fired to produce the resection with full thickness. At the same time, the opposite wall of either anterior or posterior is get protected by using a spatula. In case any bleeding is started near the circumferential staple line is started, the bleeding is then controlled using the interrupted sutures.
Complications and Risks
- Infection or leaks
- Fistula or pouch formation
- Urinary retention
After the surgery is performed, the patient needs the stay in the hospital of about 1 to 3 days of time.
Advantages of STARR (Stapled Transanal Rectal Resection) Surgery
Since STARR surgical procedure is a non invasive procedure, the patient can be recovered quickly with shorter recovery time and the complications will be less after the surgery is performed. Since the procedure involves no external incision, the surgical scars are not visible and found. The patient can resume to the regular and normal activities soon in just a few days or weeks. The patient can get back to the workplace after 15 days of time.
Cost of STARR (Stapled Trans-Anal Rectal Resection) Surgery
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