Skip to main content
Erschienen in: International Journal of Colorectal Disease 5/2014

01.05.2014 | Original Article

Tailored prolapse surgery for the treatment of haemorrhoids and obstructed defecation syndrome with a new dedicated device: TST STARR Plus

verfasst von: Gabriele Naldini, Jacopo Martellucci, Roberto Rea, Stefano Lucchini, Michele Schiano di Visconte, Angelo Caviglia, Claudia Menconi, Donglin Ren, Ping He, Domenico Mascagni

Erschienen in: International Journal of Colorectal Disease | Ausgabe 5/2014

Einloggen, um Zugang zu erhalten

Abstract

Objective

The aim of the study was to assess the safety, efficacy and feasibility of stapled transanal procedures performed by a new dedicated device, TST STARR Plus, for tailored transanal stapled surgery.

Methods

All the consecutive patients admitted to eight referral centres affected by prolapses with III-IV degrees haemorrhoids or obstructed defecation syndrome (ODS) with rectocele and/or rectal intussusception that underwent stapled transanal resection with TST STARR plus were included in the present study. Haemostatic stitches for bleeding of the suture line, specimen volume, operative time, hospital stay and perioperative complications were recorded.

Results

From 1 November 2012 to 31 March 2013, 160 consecutive patients (96 females) were enrolled in the study. In 94 patients, the prolapse was over the half of the circular anal dilator (CAD). The mean duration of the procedure was 25 min. The mean resected volume of the specimen was 13.3 cm3, the mean hospital stay was 2.2 days. In 88 patients (55 %), additional stitches on the suture line were needed (mean 2.1). Suture line dehiscence was reported in four cases, with intraoperative reinforcement. Bleeding was reported in seven patients (5 %). Urgency after 30 days was reported in one patient. No major complication occurred.

Conclusions

The new device seems to be safe and effective for a tailored approach to anorectal prolapse due to haemorrhoids or obstructed defecation.
Literatur
1.
Zurück zum Zitat Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97PubMedCrossRef Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97PubMedCrossRef
2.
Zurück zum Zitat Agachan F, Chen T, Pfeifer J, Reissman P, Wexned SD (1996) A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 39:681–685PubMedCrossRef Agachan F, Chen T, Pfeifer J, Reissman P, Wexned SD (1996) A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 39:681–685PubMedCrossRef
3.
Zurück zum Zitat Longo A (1998 June 3–6) Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. In: Proceedings of the 6th World Congress of Endoscopic Surgery. Rome Longo A (1998 June 3–6) Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. In: Proceedings of the 6th World Congress of Endoscopic Surgery. Rome
4.
Zurück zum Zitat Renzi A, Brillantino A, Di Sarno G, D'Aniello F, Giordano A, Stefanuto A, Aguzzi D, Daffinà A, Ceci F, D'Oriano G, Mercuri M, Alderisio A, Perretta L, Carrino F, Sernia G, Greco E, Picchio M, Marino G, Goglia A, Trombetti A, De Pascalis B, Panella S, Bochicchio O, Bandini A, Del Re L, Longo F, Micera O (2011) PPH-01 versus PPH-03 to perform STARR for the treatment of hemorrhoids associated with large internal rectal prolapse: a prospective multicenter randomized trial. Surg Innov 18:241–247PubMedCrossRef Renzi A, Brillantino A, Di Sarno G, D'Aniello F, Giordano A, Stefanuto A, Aguzzi D, Daffinà A, Ceci F, D'Oriano G, Mercuri M, Alderisio A, Perretta L, Carrino F, Sernia G, Greco E, Picchio M, Marino G, Goglia A, Trombetti A, De Pascalis B, Panella S, Bochicchio O, Bandini A, Del Re L, Longo F, Micera O (2011) PPH-01 versus PPH-03 to perform STARR for the treatment of hemorrhoids associated with large internal rectal prolapse: a prospective multicenter randomized trial. Surg Innov 18:241–247PubMedCrossRef
5.
Zurück zum Zitat Boccasanta P, Venturi M, Roviaro G (2011) What is the benefit of a new stapler device in the surgical treatment of obstructed defecation? Three-year outcomes from a randomized controlled trial. Dis Colon Rectum 54:77–84PubMedCrossRef Boccasanta P, Venturi M, Roviaro G (2011) What is the benefit of a new stapler device in the surgical treatment of obstructed defecation? Three-year outcomes from a randomized controlled trial. Dis Colon Rectum 54:77–84PubMedCrossRef
6.
Zurück zum Zitat Ommer A, Rolfs TM, Walz MK (2010) Long-term results of stapled transanal rectal resection (STARR) for obstructive defecation syndrome. Int J Colorectal Dis 25:1287–1292PubMedCrossRef Ommer A, Rolfs TM, Walz MK (2010) Long-term results of stapled transanal rectal resection (STARR) for obstructive defecation syndrome. Int J Colorectal Dis 25:1287–1292PubMedCrossRef
7.
Zurück zum Zitat Jayne DG, Schwandner O, Stuto A (2009) Stapled transanal rectal resection for obstructed defecation syndrome: one-year results of the European STARR Registry. Dis Colon Rectum 52:1205–1212PubMedCrossRef Jayne DG, Schwandner O, Stuto A (2009) Stapled transanal rectal resection for obstructed defecation syndrome: one-year results of the European STARR Registry. Dis Colon Rectum 52:1205–1212PubMedCrossRef
8.
Zurück zum Zitat Lenisa L, Schwandner O, Stuto A, Jayne D, Pigot F, Tuech JJ, Scherer R, Nugent K, Corbisier F, Espin-Basany E, Hetzer FH (2009) STARR with Contour Transtar: prospective multicentre European study. Colorectal Dis 11:821–827PubMedCentralPubMedCrossRef Lenisa L, Schwandner O, Stuto A, Jayne D, Pigot F, Tuech JJ, Scherer R, Nugent K, Corbisier F, Espin-Basany E, Hetzer FH (2009) STARR with Contour Transtar: prospective multicentre European study. Colorectal Dis 11:821–827PubMedCentralPubMedCrossRef
9.
Zurück zum Zitat Arroyo A, González-Argenté FX, García-Domingo M, Espin-Basany E, De-la-Portilla F, Pérez-Vicente F, Calpena R (2008) Prospective multicentre clinical trial of stapled transanal rectal resection for obstructive defaecation syndrome. Br J Surg 95:1521–1527PubMedCrossRef Arroyo A, González-Argenté FX, García-Domingo M, Espin-Basany E, De-la-Portilla F, Pérez-Vicente F, Calpena R (2008) Prospective multicentre clinical trial of stapled transanal rectal resection for obstructive defaecation syndrome. Br J Surg 95:1521–1527PubMedCrossRef
10.
Zurück zum Zitat Boccasanta P, Venturi M, Stuto A, Bottini C, Caviglia A, Carriero A, Mascagni D, Mauri R, Sofo L, Landolfi V (2004) Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial. Dis Colon Rectum 47:1285–1296PubMedCrossRef Boccasanta P, Venturi M, Stuto A, Bottini C, Caviglia A, Carriero A, Mascagni D, Mauri R, Sofo L, Landolfi V (2004) Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial. Dis Colon Rectum 47:1285–1296PubMedCrossRef
11.
Zurück zum Zitat Boccasanta P, Venturi M, Salamina G, Cesana BM, Bernasconi F, Roviaro G (2004) New trends in the surgical treatment of outlet obstruction: clinical and functional results of two novel transanal stapled techniques from a randomised controlled trial. Int J Colorectal Dis 19:359–369PubMedCrossRef Boccasanta P, Venturi M, Salamina G, Cesana BM, Bernasconi F, Roviaro G (2004) New trends in the surgical treatment of outlet obstruction: clinical and functional results of two novel transanal stapled techniques from a randomised controlled trial. Int J Colorectal Dis 19:359–369PubMedCrossRef
12.
Zurück zum Zitat Gravié JF, Lehur PA, Huten N, Papillon M, Fantoli M, Descottes B, Pessaux P, Arnaud JP (2005) Stapled hemorrhoidopexy versus milligan-morgan hemorrhoidectomy: a prospective, randomized, multicenter trial with 2-year postoperative follow up. Ann Surg 242:29–35PubMedCentralPubMedCrossRef Gravié JF, Lehur PA, Huten N, Papillon M, Fantoli M, Descottes B, Pessaux P, Arnaud JP (2005) Stapled hemorrhoidopexy versus milligan-morgan hemorrhoidectomy: a prospective, randomized, multicenter trial with 2-year postoperative follow up. Ann Surg 242:29–35PubMedCentralPubMedCrossRef
13.
Zurück zum Zitat Senagore AJ, Singer M, Abcarian H, Fleshman J, Corman M, Wexner S, Nivatvongs S (2004) Procedure for Prolapse and Hemmorrhoids (PPH) Multicenter Study Group. A prospective, randomized, controlled multicenter trial comparing stapled hemorrhoidopexy and Ferguson hemorrhoidectomy: perioperative and one-year results. Dis Colon Rectum 47(11):1824–1836PubMedCrossRef Senagore AJ, Singer M, Abcarian H, Fleshman J, Corman M, Wexner S, Nivatvongs S (2004) Procedure for Prolapse and Hemmorrhoids (PPH) Multicenter Study Group. A prospective, randomized, controlled multicenter trial comparing stapled hemorrhoidopexy and Ferguson hemorrhoidectomy: perioperative and one-year results. Dis Colon Rectum 47(11):1824–1836PubMedCrossRef
14.
Zurück zum Zitat Correa-Rovelo JM, Tellez O, Obregón L, Miranda-Gomez A, Moran S (2002) Stapled rectal mucosectomy vs. closed hemorrhoidectomy: a randomized, clinical trial. Dis Colon Rectum 45:1367–1374PubMedCrossRef Correa-Rovelo JM, Tellez O, Obregón L, Miranda-Gomez A, Moran S (2002) Stapled rectal mucosectomy vs. closed hemorrhoidectomy: a randomized, clinical trial. Dis Colon Rectum 45:1367–1374PubMedCrossRef
15.
Zurück zum Zitat Boccasanta P, Capretti PG, Venturi M, Cioffi U, De Simone M, Salamina G, Contessini-Avesani E, Peracchia A (2001) Randomised controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse. Am J Surg 182:64–68PubMedCrossRef Boccasanta P, Capretti PG, Venturi M, Cioffi U, De Simone M, Salamina G, Contessini-Avesani E, Peracchia A (2001) Randomised controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse. Am J Surg 182:64–68PubMedCrossRef
16.
Zurück zum Zitat Ho YH, Cheong WK, Tsang C, Ho J, Eu KW, Tang CL, Seow-Choen F (2000) Stapled hemorrhoidectomy–cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months. Dis Colon Rectum 43:1666–1675PubMedCrossRef Ho YH, Cheong WK, Tsang C, Ho J, Eu KW, Tang CL, Seow-Choen F (2000) Stapled hemorrhoidectomy–cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months. Dis Colon Rectum 43:1666–1675PubMedCrossRef
17.
Zurück zum Zitat Naldini G (2011) Serious unconventional complications of surgery with stapler for haemorrhoidal prolapse and obstructed defaecation because of rectocoele and rectal intussusception. Colorectal Dis 13:323–327PubMedCrossRef Naldini G (2011) Serious unconventional complications of surgery with stapler for haemorrhoidal prolapse and obstructed defaecation because of rectocoele and rectal intussusception. Colorectal Dis 13:323–327PubMedCrossRef
18.
Zurück zum Zitat Wadhawan H, Shorthouse AJ, Brown SR (2010) Surgery for obstructed defaecation: does the use of the Contour device (Trans-STARR) improve results? Colorectal Dis 12:885–890PubMedCrossRef Wadhawan H, Shorthouse AJ, Brown SR (2010) Surgery for obstructed defaecation: does the use of the Contour device (Trans-STARR) improve results? Colorectal Dis 12:885–890PubMedCrossRef
19.
Zurück zum Zitat Boccasanta P, Venturi M, Roviaro G (2007) Stapled transanal rectal resection versus stapled anopexy in the cure of hemorrhoids associated with rectal prolapse. A randomized controlled trial. Int J Colorectal Dis 22:245–251PubMedCrossRef Boccasanta P, Venturi M, Roviaro G (2007) Stapled transanal rectal resection versus stapled anopexy in the cure of hemorrhoids associated with rectal prolapse. A randomized controlled trial. Int J Colorectal Dis 22:245–251PubMedCrossRef
20.
Zurück zum Zitat Naldini G, Martellucci J, Talento P, Caviglia A, Moraldi L, Rossi M (2009) New approach to large haemorrhoidal prolapse: double stapled haemorrhoidopexy. Int J Colorectal Dis 24:1383–1387PubMedCrossRef Naldini G, Martellucci J, Talento P, Caviglia A, Moraldi L, Rossi M (2009) New approach to large haemorrhoidal prolapse: double stapled haemorrhoidopexy. Int J Colorectal Dis 24:1383–1387PubMedCrossRef
21.
Zurück zum Zitat Braini A, Narisetty P, Favero A, Calandra S, Calandra A, Caponnetto F, Digito F, Da Pozzo F, Marcotti E, Porebski E, Rovedo S, Terrosu G, Torricelli L, Stuto A (2013 Jan 20) Double PPH technique for hemorrhoidal prolapse: a multicentric, prospective, and nonrandomized trial. Surg Innov. PubMed PMID: 23339147 Braini A, Narisetty P, Favero A, Calandra S, Calandra A, Caponnetto F, Digito F, Da Pozzo F, Marcotti E, Porebski E, Rovedo S, Terrosu G, Torricelli L, Stuto A (2013 Jan 20) Double PPH technique for hemorrhoidal prolapse: a multicentric, prospective, and nonrandomized trial. Surg Innov. PubMed PMID: 23339147
22.
Zurück zum Zitat Stuto A, Favero A, Cerullo G, Braini A, Narisetty P, Tosolini G (2012) Double stapled haemorrhoidopexy for haemorrhoidal prolapse: indications, feasibility and safety. Colorectal Dis 14:e386–e389PubMedCrossRef Stuto A, Favero A, Cerullo G, Braini A, Narisetty P, Tosolini G (2012) Double stapled haemorrhoidopexy for haemorrhoidal prolapse: indications, feasibility and safety. Colorectal Dis 14:e386–e389PubMedCrossRef
23.
Zurück zum Zitat Naldini G, Martellucci J, Moraldi L, Romano N, Rossi M (2009) Is simple mucosal resection really possible? Considerations about histological findings after stapled hemorrhoidopexy. Int J Colorectal Dis 24:537–541PubMedCrossRef Naldini G, Martellucci J, Moraldi L, Romano N, Rossi M (2009) Is simple mucosal resection really possible? Considerations about histological findings after stapled hemorrhoidopexy. Int J Colorectal Dis 24:537–541PubMedCrossRef
24.
Zurück zum Zitat Festen S, Molthof H, van Geloven AA, Luchters S, Gerhards MF (2012) Predictors of recurrence of prolapse after procedure for prolapse and haemorrhoids. Colorectal Dis 14:989–996PubMedCrossRef Festen S, Molthof H, van Geloven AA, Luchters S, Gerhards MF (2012) Predictors of recurrence of prolapse after procedure for prolapse and haemorrhoids. Colorectal Dis 14:989–996PubMedCrossRef
25.
Zurück zum Zitat Pescatori M, Gagliardi G (2008) Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Tech Coloproctol 12:7–19PubMedCentralPubMedCrossRef Pescatori M, Gagliardi G (2008) Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Tech Coloproctol 12:7–19PubMedCentralPubMedCrossRef
26.
Zurück zum Zitat FDA (2012) General Hospital Devices and Supplies. Surg Innov 20:553–558 FDA (2012) General Hospital Devices and Supplies. Surg Innov 20:553–558
27.
Zurück zum Zitat Arroyo A, Pérez-Vicente F, Miranda E, Sánchez A, Serrano P, Candela F, Oliver I, Calpena R (2006) Prospective randomized clinical trial comparing two different circular staplers for mucosectomy in the treatment of hemorrhoids. World J Surg 30:1305–1310PubMedCrossRef Arroyo A, Pérez-Vicente F, Miranda E, Sánchez A, Serrano P, Candela F, Oliver I, Calpena R (2006) Prospective randomized clinical trial comparing two different circular staplers for mucosectomy in the treatment of hemorrhoids. World J Surg 30:1305–1310PubMedCrossRef
28.
Zurück zum Zitat Giuratrabocchetta S, Pecorella G, Stazi A, Tegon G, De Fazio M, Altomare DF (2013) Safety and short-term effectiveness of EEA stapler vs PPH stapler in the treatment of degree III haemorrhoids: prospective randomized controlled trial. Colorectal Dis 15:354–358PubMedCrossRef Giuratrabocchetta S, Pecorella G, Stazi A, Tegon G, De Fazio M, Altomare DF (2013) Safety and short-term effectiveness of EEA stapler vs PPH stapler in the treatment of degree III haemorrhoids: prospective randomized controlled trial. Colorectal Dis 15:354–358PubMedCrossRef
29.
Zurück zum Zitat Dindo D, Hahnloser D (2013) Anal mucosectomy for haemorrhoids: should we start to speak Chinese? Colorectal Dis 15:e186–e189PubMedCrossRef Dindo D, Hahnloser D (2013) Anal mucosectomy for haemorrhoids: should we start to speak Chinese? Colorectal Dis 15:e186–e189PubMedCrossRef
30.
Zurück zum Zitat Petersen S, Schinkel B, Jürgens S, Taylessani C, Schwenk W (2013) Impact of prolapse mass on Contour(®) Transtar™ technique for third-degree rectal prolapse. Int J Colorectal Dis 28:1027–1030PubMedCrossRef Petersen S, Schinkel B, Jürgens S, Taylessani C, Schwenk W (2013) Impact of prolapse mass on Contour(®) Transtar™ technique for third-degree rectal prolapse. Int J Colorectal Dis 28:1027–1030PubMedCrossRef
31.
Zurück zum Zitat Martellucci J, Naldini G, Del Popolo G, Carriero A (2012) Sacral nerve modulation in the treatment of chronic pain after pelvic surgery. Colorectal Dis 14:502–507PubMedCrossRef Martellucci J, Naldini G, Del Popolo G, Carriero A (2012) Sacral nerve modulation in the treatment of chronic pain after pelvic surgery. Colorectal Dis 14:502–507PubMedCrossRef
Metadaten
Titel
Tailored prolapse surgery for the treatment of haemorrhoids and obstructed defecation syndrome with a new dedicated device: TST STARR Plus
verfasst von
Gabriele Naldini
Jacopo Martellucci
Roberto Rea
Stefano Lucchini
Michele Schiano di Visconte
Angelo Caviglia
Claudia Menconi
Donglin Ren
Ping He
Domenico Mascagni
Publikationsdatum
01.05.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
International Journal of Colorectal Disease / Ausgabe 5/2014
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-014-1845-7

Weitere Artikel der Ausgabe 5/2014

International Journal of Colorectal Disease 5/2014 Zur Ausgabe

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 Ablationstherapie Nachrichten

Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Ureterstriktur: Innovative OP-Technik bewährt sich

19.04.2024 EAU 2024 Kongressbericht

Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.