Annals of Coloproctology

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Anorectal physiology & pelvic floor disorder

Transverse perineal support improves long-term outcomes in patients undergoing stapled transanal rectal resection for obstructed defecation syndrome: a multicenter observational case-control study: Adolfo Renzi, Luigi Marano, Pasquale Talento, Luigi Brusciano, Angela Pezzolla, Domenico Izzo, Carmine Antropoli, Francesco D’Aniello, Giandomenico Di Sarno, Gianluca Minieri, Grazia Cantore, Gianmattia Terracciano, Domenico Barbato, Ludovico Docimo, Massimo Antropoli, Alessio Palumbo, Michele Lanza, Emanuele Mario Caputi, Antonio Brillantino; Ann Coloproctol. 2025;41(4):330-337. Published online August 25, 2025; DOI: https://doi.org/10.3393/ac.2025.00073.0010

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Purpose
To evaluate the safety and long-term efficacy of stapled transanal rectal resection (STARR) combined with the transverse perineal support (TPS) procedure in the surgical treatment of obstructed defecation syndrome (ODS) associated with internal rectal prolapse and excessive perineal descent (PD).
Methods
This multicenter observational case-control study involved 7 European centers. During the initial study period, patients underwent STARR alone (group 1), while in the subsequent period, patients received STARR combined with TPS (group 2). All patients were followed clinically at 6, 12, 36, and 60 months, and were offered radiological evaluation between 3 and 5 years postoperatively.
Results
The median postoperative ODS score was similar between groups at 6 months (6 [range, 2–15] vs. 5 [range, 2–13]; P=0.16, Mann-Whitney U-test), but at 36 months, it was significantly lower in group 2 compared to group 1 (11 [range, 5–16] vs. 5 [range, 2–15]; P<0.001, Mann-Whitney U-test), with stable results maintained through 5 years. The success rate followed a similar trend. Postoperative maximum PD during straining remained unchanged in group 1, whereas it significantly decreased compared to preoperative values in group 2.
Conclusion
The addition of TPS to STARR in the surgical treatment of ODS associated with internal rectal prolapse and excessive PD appears to significantly improve long-term success rates and correct descending perineum.

Citations

Citations to this article as recorded by

Laparoscopic Resection Rectopexy with Transanal Specimen Extraction for Complete Rectal Prolapse: Retrospective Cohort Study of Functional Outcomes
Mustafa Ates, Sami Akbulut, Emrah Sahin, Kemal Baris Sarici, Ertugrul Karabulut, Mukadder Sanli
Journal of Clinical Medicine.2026; 15(2): 718. CrossRef
Beyond stapled transanal rectal resection vs ventral rectopexy dichotomy: Toward a phenotype-guided surgical paradigm for obstructed defecation syndrome
Michele Schiano di Visconte, Sonia Sarnari
World Journal of Gastrointestinal Surgery.2026;[Epub] CrossRef
The Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of obstructed and ineffective defecation syndrome
Adolfo Renzi, Luigi Brusciano, Pasquale Talento, Luigi Marano, Francesca Iacobellis, Antonio Vallo, Giovanna Frezza, Maurizio Grillo, Alessio Palumbo, Elisa Palladino, Benedetto Neola, Fabrizio Foroni, Michele Lanza, Massimo Antropoli, Carmine Antropoli,
Annals of Coloproctology.2026; 42(2): 151. CrossRef
Early outcomes of transverse perineal support in obstructed defecation syndrome with pathological perineal descent; a prospective cohort study
Haitham M. Azmy Basiouny, Ali Ahmed Shafik, Mohamed Yehia Elbarmelgi, Osama Refaie, Mohamed Tamer, Mahmoud Adel Abu Alwafa, Ahmed Mohamed Abdelaal
BMC Surgery.2026;[Epub] CrossRef
Tailoring surgery for obstructed defecation and its evolution into ineffective defecation: a new staging of the syndrome and a site-specific decision algorithm
Adolfo Renzi
Annals of Coloproctology.2026; 42(3): 372. CrossRef

Early Experience with a Stapled TransAnal Rectal Resection for Obstructed Defecation Syndrome.: Shin, Jong Keun , Kwak, Chang Shin , Park, Jung Soo , Choi, Sung Il , Lee, Jae Bum , Park, Hyun Joo , Lee, So Jin , Lee, Doo Han , Kim, Do Sun; J Korean Soc Coloproctol. 2007;23(1):1-9.; DOI: https://doi.org/10.3393/jksc.2007.23.1.1

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Abstract PDF: PURPOSE
This study was designed to assess the early outcome of a stapled transanal rectal resection (STARR) in obstructed defecation syndrome (ODS) patients with rectocele and rectal intussusception.
METHODS
From January to December in 2005, 41 patients with the symptoms of obstructed defecation and the findings of rectocele and rectal intussusception in defecography, who failed in conservative management, were enrolled in this study. All patients underwent the STARR procedure. Preoperatively all patients received colonoscopy, a colon transit time test, cinedefecography, etc. The constipation score was evaluated by using the Cleveland Clinic Florida (CCF) constipation score preoperatively and at 1 month and 3 months after operation.
RESULTS
The mean age of the patients was 55.3 (19~76) years. There were three males and thirty-eight females. The mean operation time was 39.3 (25~80) minutes, and the mean hospital stay was 4.2 (4~6) days. Complications were fecal urgency in 9 cases (21.9%), which improved after 3 months, bleeding in 5 cases (12.2%), and anastomotic stenosis in 1 case (2.4%). At postoperative defecography, both intussusception and rectocele had disappeared in most patients. All constipation symptoms were significantly improved (P < 0.01). The mean CCF constipation score was 17.6 (11~24) preoperatively, and improved to 9.1 after 1 month and 8.2 after 3 months (P < 0.01). The overall patient satisfaction was graded as excellent, good, fairly good and poor in 19 cases (46.3%), 13 cases (31.7%), 4 cases (9.7%), and 5 cases (12.2%), respectively.
CONCLUSION
The STARR procedure seems to be a safe and effective procedure in ODS patients with rectocele and rectal intussusception. However, further study of the long-term results is required.

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