The STARR (Stapled Transanal Rectal Resection) procedure is a minimally invasive surgical technique designed to treat obstructed defecation syndrome (ODS), a condition often associated with rectal prolapse, rectocele, and intussusception. Introduced in the early 2000s, the STARR procedure has gained prominence for its efficacy in alleviating symptoms and improving the quality of life for patients with refractory ODS.
Indications The primary indication for the STARR procedure is obstructed defecation syndrome (ODS) that does not respond to conservative treatments such as dietary modifications, pelvic floor exercises, or pharmacotherapy. Patients with the following conditions may be considered for the STARR procedure:
Rectocele: A bulging of the rectum into the vagina. Rectal intussusception: The telescoping of one part of the rectum into another. Rectal prolapse: A condition where the rectum protrudes through the anus. Preoperative Assessment Before undergoing the STARR procedure, a thorough preoperative assessment is essential. This includes:
Clinical Evaluation: A detailed history and physical examination to assess the severity and impact of symptoms. Imaging Studies: Defecography, MRI, or endoanal ultrasound to evaluate the anatomical abnormalities. Manometry: Anorectal manometry to measure the pressures in the rectum and anal sphincter. Colonoscopic Examination: To rule out other colonic pathologies. Surgical Technique The STARR procedure involves the following key steps:
Anesthesia: The procedure is performed under general or regional anesthesia. Patient Positioning: The patient is placed in the lithotomy position. Insertion of Stapler: A specially designed circular stapler is inserted transanally. Tissue Excision: The stapler is used to resect the redundant rectal tissue causing the obstruction. Anastomosis: The stapler creates an anastomosis, joining the remaining rectal tissue ends. Hemostasis: Ensuring no bleeding and verifying the integrity of the anastomosis. The entire procedure typically takes about 60-90 minutes.
Postoperative Care After the STARR procedure, patients require close monitoring and appropriate postoperative care, which includes:
Pain Management: Administration of analgesics to manage pain. Dietary Recommendations: A gradual reintroduction of diet starting with liquids and progressing to solid foods. Laxatives: Mild laxatives may be prescribed to ensure smooth bowel movements. Follow-Up: Regular follow-up appointments to monitor recovery and address any complications. Complications As with any surgical procedure, the STARR procedure carries potential risks and complications, including:
