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Decision-making Algorithm for the STARR procedure in Obstructed Defecation Syndrome: Position statement of the group of STARR Pioneers

Department of Surgery, Caritas-Krankenhaus St. Josef, Regensburg, oschwandner{at}caritasstjosef.de

Angelo Stuto, MD

Department of Surgery, Ospedale S. Maria degli Angeli, Pordenone

David Jayne, MD

Academic Surgical Unit, St. James University Hospital, Leeds

Leonardo Lenisa, MD

Department of Surgery, Casa di Cura San Pio X, Milan Italy

François Pigot, MD

Department of Proctology, Bagatelle-Maison de Sante, Talence-Cedex

Jean-Jacques Tuech, MD

Department of Digestive Surgery, University Hospital, Rouen France

Roland Scherer, MD

Department of Surgery, Krankenhaus Waldfriede, Berlin Germany

Karen Nugent, MD

Department of Surgery, Southampton General Hospital, Southampton United Kingdom

Fabrice Corbisier, MD

Department of Surgery, Notre-Dame, Charleroi, Belgium

Eloy E. Basany, MD

Department of Surgery, Hospital Valle de Hebron, Barcelona, Spain

Franc H. Hetzer, MD

Department of Surgery, Kantonsspital, St. Gallen, Switzerland

Internal rectal prolapse (rectal intussusception) and rectocele are frequent clinical findings in patients suffering from refractory constipation that may be best characterized as obstructive defecation syndrome. However, there is still no clear evidence whether the stapled transanal rectal resection (STARR) procedure provides a safe and effective surgical option for symptom resolution in patients with obstructive defecation syndrome, as evidence-based guidelines and functional long-term results are still missing. On the basis of the need for objective evaluation, a European group of experts was founded (Stapled Transanal Rectal Resection Pioneers). Derived from 2 meetings (October 26-28, 2006, Gouvieux, France and November 28-29, 2007, St Gallen, Switzerland) a concept for treatment options in patients suffering from obstructive defecation syndrome was developed, including a clear decision-making algorithm specifically focusing on the role of the stapled transanal rectal resection procedure based on clinical symptoms and dynamic imaging and inclusion and exclusion criteria for the stapled transanal rectal resection procedure.

Key Words: STARR • obstructive defecation syndrome • rectocele • internal rectal prolapse • algorithm

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