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Standard stapled transanal rectal resection vs stapled transanal rectal resection with only one high volume stapler in the prevention of complications in old patient: our experience.

BACKGROUND
The causes of obstructed defecation syndrome (ODS) can actually be either functional or mechanical (primary or secondary deficit of the sensitivity, slow bowel transit, pelvic floor dyssynergia, internal and external rectal prolapse, recto-anal intussusceptions, anterior or posterior rectocele and pelvic prolapse of the bladder, uterus, bowel or sigma). The aim of our study was evaluate the safety, efficacy and feasibility of Transanal Rectal Resection (STARR) procedure performed by a single or double stapler through clinical and functional outcomes for transanal stapled surgery.


METHODS
From January 2016 to October 2017, ninety patients with ODS secondary to rectal prolapse, anal-rectal intussusception and anterior rectocele, that underwent to a STARR procedures were enrolled. Thirty of these underwent a STARR procedure with double circular stapler PPH-01 (Group A); 30 with single circular stapler CPH34HV with a purse string suture (Group B); and 30 with single circular stapler CPH34HV with a "parachute technique" (Group C). All patients were selected with clinical examination, Wexner score for fecal incontinence and ODS score for constipation. Patients also underwent a Defeco RMN for an anatomical and dynamic evaluation of the pelvic floor.


RESULTS
No recurrence rates were observed in the three groups. The mean operative time was 46,3 minutes in group A; 34,5 minutes in group B; and 37,6 minutes in Group C. The volume of the resected specimen was 17 ml in group A; 15 ml in group B; and 16 ml in Group C. Complications were bleeding (3.3% in group A); fecal urgency (6.6% in group A, 10% in group B and 3.3% in group C); rectal hematoma (3.3% in group A). All symptoms significantly improved after the operation without differences between groups.


CONCLUSIONS
The STARR technique performed with a single stapler CPH34HV is safe, faster and less expensive than the STARR performed by a double PPH01. Besidas, with the parachute technique, it is possible to resect asymmetric prolapses.