Long term Anatomical and Functional outcome of the STARR Procedure: P156

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Aim:Patients with evacuation difficulties attributed to a rectocoele often have a combination of functional and anatomical abnormalities. We aimed to assess the effect of STARR on these abnormalities together with the symptoms thatpredicted good outcome.Method:Seventeen women (age range 37-79, parity 1-5) with a symptomatic rectocoele underwent the STARRprocedure. They had the followingpre- and post-procedure: dynamic anatomical assessment (Barium and MRproctography), functional assessment (Wexner questionnaires and anorectal physiology). Mean duration of follow up was 17 months.Results:Mean Wexner scores fell from 15 to10. Mean surface area resected was 25.8 (15- 40.25) cm2. The change in Wexner scores correlated with change in surface area (P = 0.005). Baproctography revealed new peritoneoceles in three of six patients assessed. On MRproctography 25- 38% developed anterior or central compartmentprolapse. Two patients required a re-doprocedure using a transvaginal approach, two required SNS for faecal incontinence. Those without anismus had fewer recurrences of symptoms.Conclusion:Whilst the STARRprocedure improved bowel evacuation in some patients, itpredisposed towards new and worseningprolapse of pelvic viscera and new onset of incontinence in 12%. STARR should be cautiously considered in those with anismus, faecal incontinence and pelvic organprolapse.

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