Bleeding, incontinence, pain and constipation after STARR transanal double stapling rectotomy for obstructed defecation.
Bleeding, incontinence, pain and constipation after STARR transanal double stapling rectotomy for obstructed defecation.
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DOI：
10.1007/s10151-003-0026-4
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发表时间：
2003-10-01
影响因子：
3.3
通讯作者：
Pescatori, M
中科院分区：
文献类型：
--
作者：
Dodi, G;Pietroletti, R;Pescatori, M
背景：STARR双吻合术（DSP），即经肛门直肠前后切除术，最近被报道为治疗直肠前突和直肠内粘膜脱垂（R-IMP）引起的排便障碍的一种低发病率和有效的手术。我们报告了这种新手术后的并发症和症状复发。患者和方法：14名患有慢性便秘的女性，年龄36-72岁，在使用两个圆形吻合器进行DSP后出现严重并发症或症状复发。所有患者在DPS后的中位随访期为12个月（范围2-24）。结果：2例患者术后出现严重直肠出血。7例患者报告了持续严重的肛门疼痛，均表现为焦虑。其中四只是多胞胎。3例患者大便失禁，均为阴道分娩。R-IMP复发6例，排便障碍7例。再次干预4例，1例缝合出血区，1例切除复发性脱垂，1例治疗阴囊，1例治疗直肠狭窄。4例患者需要生物反馈训练治疗非松弛性耻骨直肠肌，2例需要心理治疗。结论：胎次、痉挛性底综合征和精神神经症可能是导致DSP手术失败的危险因素，可能出现严重的并发症和早期症状复发，需要再次手术。
BACKGROUND: The STARR double stapling procedure (DSP), i. e. transanal anteroposterior rectotomy, has been recently reported as a low-morbidity and effective operation for the treatment of rectocele and internal rectal mucosal prolapse (R-IMP) causing obstructed defecation. We report the postoperative complications and recurrence of symptoms following this novel operation.PATIENTS AND METHODS: Fourteen chronically constipated women with RIMP, aged 36-72 years, presented with either severe complications or recurrence of symptoms following DSP performed by means of two circular staplers. All were followed for a median period of 12 months (range, 2-24) after DPS.RESULTS: Severe rectal bleeding occurred in two cases postoperatively. Persistent severe anal pain was reported by seven patients, all presenting with anxiety. Four of them were multiparous. Three patients had fecal incontinence, both had vaginal deliveries. R-IMP recurred in six, obstructed defecation in seven cases. Four patients needed reintervention, one for suturing the bleeding area, one excising the recurrent prolapse, one for colpocele and one for rectal stricture. Four patients required biofeedback training for non-relaxing puborectalis and two needed psychotherapy.CONCLUSION: Parity, spastic floor syndrome and psychoneurosis seem to be the risk factors predisposing to failure of DSP, which may be followed by severe complications and early recurrence of symptoms requiring reoperation.