ORIGINAL CONTRIBUTION Results, Outcome Predictors, and Complications after Stapled Transanal Rectal Resection for Obstructed Defecation Giuseppe Gagliardi, M.D., 1  Mario Pescatori, M.D., F.R.C.S., E.B.S.Q., 2  Donato F. Altomare, M.D., 3  Gian Andrea Binda, M.D., 4  Corrado Bottini, M.D., 5  Giuseppe Dodi, M.D., 6  Vincenzino Filingeri, M.D., 7  Giovanni Milito, M.D., 8  Marcella Rinaldi, M.D., 3  Giovanni Romano, M.D., 9  Liana Spazzafumo, M.S., 10  Mario Trompetto, M.D. 11 on behalf of the Italian Society of Colo-Rectal Surgery (SICCR) 1 General Surgery, Clinica Pineta Grande, Caserta, Italy 2 Coloproctology Unit, Villa Flaminia Hospital, Rome, Italy 3 Department of Emergency and Organ Transplantation, General Surgery and Liver Transplantation Unit, University of Bari, Bari, Italy 4 Coloproctology Unit, Ospedale Galliera, Genoa, Italy 5 Coloproctology Unit, Ospedale S. Antonio Abate, Gallarate, Varese, Italy 6 Coloproctology Unit, University of Padua, Padua, Italy 7 General Surgery, Ospedale S. Eugenio, Rome, Italy 8 Coloproctology Unit, University of Rome Tor Vergata, Rome, Italy 9 Coloproctology Unit, Ospedale Moscati, Avellino, Italy 10 Center of Biometric and Medical Statistics INRCA - Ancona, Ancona, Italy 11 Coloproctology Unit, Clinica S. Gaudenzio, Novara, Italy PURPOSE: Obstructed defecation may be treated by stapled transanal rectal resection, but different complications and recurrence rates have been reported. The present study was designed to evaluate stapled transanal rectal resection results, outcome predictive factors, and nature of complications. METHODS: Clinical and functional data of 123 patients were retrospectively analyzed. All patients had symptoms of obstructed defecation before surgery and had rectocele and/or intussusception. Of them, 85 were operated on by the authors and 38 were referred after stapled transanal rectal resection had been performed elsewhere. RESULTS: At a median follow-up of 17 (range, 3–44) months, 65 percent of the patients operated on by the authors had subjective improvement. Recurrent rectocele was present in 29 percent and recurrent intussusception was present in 28 percent of patients. At univariate analysis, results were worse in those with preoperative digitation (P <0.01), puborectalis dyssynergia (P <0.05), enterocele (P <0.05), larger size rectocele (P <0.05), lower bowel frequency (P <0.05), and sense of incomplete evacuation (P <0.05). Bleeding was the most common perioperative complication occurring in 12 percent of cases. Reoperations were needed in 16 patients (19 percent): 9 for recurrent disease. In the 38 patients referred after stapled transanal rectal resection, the most common problems were perineal pain (53 percent), constipation with recurrent rectocele and/or intussuscep- tion (50 percent), and incontinence (28 percent). Of these patients, 14 (37 percent) underwent reoperations: 7 for recurrence. Three patients presented with a rectovaginal fistula. One other patient died for necrotizing pelvic fasciitis. CONCLUSIONS: Stapled transanal rectal resection achieved acceptable results at the cost of a high reoperation rate. Patients with puborectalis dyssynergia and lower bowel frequency may do worse because surgery does not address the causes of their constipation. Patients with large rectoceles, enteroceles, digitation, and a sense of incom- plete evacuation may have more advanced pelvic floor disease for which stapled transanal rectal resection, which simply removes redundant tissue, may not be adequate. This, together with the complications observed in patients referred after stapled transanal rectal resection, suggests that this procedure should be performed by colorectal surgeons and in carefully selected patients. KEY WORDS: Transanal surgery; Outlet obstruction; Intussusception; Rectocele; Pelvic floor disease; Stapled transanal rectal resection; STARR. Read at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 3 to 7 2006. Reprints are not available. Address of correspondence: Giuseppe Gagliardi, M.D., General Surgery, Clinica Pineta Grande, Via Domiziana Km. 30, Castel Volturno (Caserta) 81030, Italy. E-mail: gagliarg@yahoo.com DOI: 10.1007/s10350-007-9096-0  VOLUME 51: 186–195 (2008)  ©THE ASCRS. 2007 186