STARR vs internal delorme for obstructed defecation: a prospective randomized trial.

Transanal rectal resection with two circular staplers (STARR) and transanal mucosectomy (endorectal proctopexy or Internal Delorme) are two effective surgical approaches to severe obstructed defecation syndrome (ODS)associated to rectocele and rectal intussusception. Thirteen cinsecutive patients with ODS (average age 56.6 years) underwent surgery at Luigi Sacco University Hospital of Milan between October 2009 and February 2011. After routinely preoperative diagnostic work-up, patients were randomized to STARR (n=7) or Delorme procedure (n=6). All patients were submitted to three questionnaires: SF-36, ODS score and Wexner Continence Score before and after surgery (3 months, 1 and 4 years). All data and post operative complaints were recorded and collected by an independent investigator. All variables related to ODS symptoms have improved with both surgical techniques at 3 months, 1 year and 4 years (p<0,05). No major complication occurred. The overall short-term minor complications rate was 3/7 in the STARR group and 3/6 in the Internal Delorme group. Our study confirms the safety and the efficacy of the surgical approach with STARR or with Internal Delorme procedure 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.