Improved STARR Combined With Perioperative Biofeedback Treatment : A Novel Therapy For Obstructed Defecation Syndrome

Objective: To investigate the clinical efficacy and safety of improved stapled transanal rectal resection(STARR)combined with perioperative pelvic floor biofeedback therapy in treating obstructed defecation syndrome(ODS).Methods: Thirty female patients suffered ODS adopted the therapy of improved STARR combined with perioperative biofeedback treatment in Department of Colorectal and Anal Surgery,the First Hospital of Jilin university from October 2014 to January 2016,were analyzed retrospectively.Ahead of the improved STARR surgery,the patients needed to take a course of pelvic floor biofeedback therapy(20 min/time,2 times/d,10 times for a course of treatment),another 2 courses should also be taken after discharge.Efficacy evaluation including the general situation and the postoperative complications of patients,overall satisfaction(excellent: without any symptoms;good: 1 ~ 2 times laxatives a month and needs no any other auxiliary defecation;fairly good: more than 3 times laxatives a month;poor: with no improvement),Longo ODS score(a score of 0 ~ 40 points,the higher scores,the more severe symptoms),gastrointestinal quality of life index(a score of 0 ~ 144 points,the lower scores,the more severe symptoms),anorectal manometry and defecography examination.The follow-up time lasted 12 months(ended at February 2017).Results:The procedure was completed successfully in all thirty patients,average operation time 25(18~34)minutes,the mean length of hospital stay 6(4~9)days.Postoperative complications included pain 20%(6/30),urinary retention 16.7%(5/30),anorectal heaviness 6.7%(2/30),fecal urgency 26.6%(8/30),anaorectal heaviness and fecal urgency disappeared in there months.No severe complications,such as postoperative bleeding,infection,rectovaginal fistula,anastomotic dehiscence and anal incontinence.The overall response rate was 93.3%(28/30),failure rate 6.7%(2/30)in the follow-up 12 months.There was no statistic significance of ODS scores between pre-therapy and preoperative(pre-therapy:32.95±3.22,preoperative:32.85±3.62,t=1.472,P=0.163).Compared with the pre-therapy,scores at 1 week after the operation decreased(t=4.306,P=0.000).Moreover,scores at 1 month after the operation were lower than that at 1 week(13.05±7.49 vs 15±7.17,t=7.322,P=0.000),while no difference was found in 1,3,6,12 months after operation(F=2.111,P=0.107).Likewise,no statistic significance of GIQLI scores were noticed between pre-therapy and preoperative(pre-therapy:79.39±17.14,preoperative:76.65±17.56,t=1.735,P=0.096).Compared with the pre-therapy,scores at 1 week after the operation increased(t=4.714,P=0.000).Furthermore,scores at 1 month after the operation were higher than that at 1 week(102.26±19.24 vs 91.31±21.35,t=5.628,P=0.000),while no difference was found in 1,3,6,12 months after operation(F=1.211,P=0.313).In comparision with pre-therapy,parameters of the defecography examination at 12 months after operation showed tremendous improvement,the rectocele from(34.1±0.4)mm down to(3.1±0.3)mm(t=6.847,P=6.847),anorectal angles during defecation from(123.8±6.7)° up to(134.7±8.5)°,enlargement of anorectal angles during defecation from(29.1±3.5)° up to(37.1±5.3)°.Meanwhile,the descend of perineum,anorectal angles at rest as well as parameters of anorectal manometry showed no statistically significant difference(P > 0.05).Conclusions: Improved STARR combined with perioperative biofeedback therapy is safe and effective for ODS patients,and is well worth being used widely.