STARR vs. internal Delorme procedure for obstructed defecation: functional and QoL long-term results

BACKGROUND: Stapled trans-anal rectal resection (STARR) and trans-anal mucosectomy (internal Delorme) are two effective surgical ap-proaches for severe obstructed defecation syndrome (ODS) associated with rectocele and rectal intussusception. METHODS: Twelve consecutive patients with ODS underwent surgery at Luigi Sacco University Hospital of Milan between October 2009 and February 2011. After routinely preoperative diagnostic work-up, patients were randomly assigned either to STARR or Delorme study group. ODS score and Wexner Continence score were calculated before surgery, and 3, 12, 24, 48, and 96 months postoperatively. Furthermore, patients were administered the SF-36 questionnaire before and 3, 12, 24, and 96 months after surgery. 30-day postoperative complaints were recorded by a third investigator, different from the main surgeon. RESULTS: The mean ODS scores have improved with both surgical techniques at 3 months and 4 years (P<0.05). Mean ODS score had signifi-cantly improved just with Delorme procedure at the 8-year follow-up (P<0.05). STARR procedure reduces the hospital stay from 6 to 3 days and the operative time from 102 to 53 minutes (P=0.0009). CONCLUSIONS: Our study confirms the efficacy of both surgical approaches in selected patients with ODS. Global health and psychological well-being at 3 months, 1 year and 4 years after surgery are similar for both techniques, whilst STARR procedure seems to have worse outcome and impact on the mental status at a long-term follow-up (P<0,05).