Surgery for obstructed defecation: An overview and our experience with the most recently introduced procedure (STARR)

Recently, colorectal surgeons are often asked to deal with constipated patients. This invalidating condition is nowadays commonly referred to the coloproctologist as a disorder strongly affecting the quality of life of the patient. The outlet obstruction syndrome (OOS) is usually associated to functional and anatomic alterations such as rectal intussusception and rectocele. Between 2002 and 2005, 85 patients were operated on with a STARR procedure for obstructed defecation, rectal intussusception and rectocele in seven Italian centres and 38 patients were referred to the authors after STARR performed elsewhere. Rectocele and intussusception recurred respectively in 29% and 27% of our patients and 53% of them were still on laxatives postoperatively. Indications and results of all the other conventional techniques are discussed in this work. The OOS has a multifactorial aetiology of which rectocele and rectal intussusception are only the emerged areas of an iceberg. Until today there is not a procedure that can deal with all the multiple factors underlying the OOS, thus there is not a surgical gold standard. STARR may treat the effects and not the cause or, at least, not all the causes of the disease, nevertheless it may be a good surgical option in selected patients (1-3).