Surgeons performing a new procedure to treat chronic constipation

Mayo Clinic surgeons are performing a new procedure to treat women with chronic constipation from obstructive defecation syndrome (ODS). The stapled transanal rectal resection (STARR) is a minimally invasive surgical procedure that’s an alternative to traditional surgery to correct the problem.

The surgeon performs STARR through the anus, so the procedure requires no external incisions and leaves no visible scars. Patients are typically hospitalised from one-to-three days and may begin having normal bowel movements after the surgery. “It’s a simple, very promising procedure,” says Dr. Paul Pettit, a Mayo Clinic urogynaecologic surgeon who performs STARR. The surgeon uses a surgical stapler to remove excess tissue in the rectum responsible for ODS. This tissue may bulge out, creating a pocket near the anus (rectocele), and it may fold up on itself like a telescope (intussuseption). Pettit says the traditional surgery is done through the vagina to basically tighten the tissues between the rectum and the vagina, but excess rectal tissue itself is not removed. Another disadvantage to traditional surgery for a rectocele is the possibility of making the vagina shorter and or narrower. The STARR procedure does not compromise the vagina in anyway. “The most common report we’ve had from patients is that it’s easier to have a bowel movement,” says Mayo Clinic colorectal surgeon Dr. Heidi Chua. “There’s less need for laxatives and the constant need to strain, and the feeling that they’re not finished is eliminated.” However, Chua says there’s no long term data yet comparing the effectiveness of the STARR procedure with traditional surgery. ODS is a form of chronic constipation that affects thousands of Americans-primarily women. Childbirth can weaken the pelvic floor muscles. Weakened muscles contribute to a condition called uterine prolapse, where the uterus drops from its normal position and protrudes into the vaginal canal. Prolapse often precedes or accompanies ODS. For that reason, most patients will require other reconstructive procedures to receive the maximum benefit from the STARR procedure. Symptoms of ODS include: prolonged straining, incomplete elimination (not passing the entire stool), a prolonged time to have a bowel movement, the need for routine use of laxatives or enemas, and the need to press around the genitals or anus in order to have a bowel movement. Women with chronic constipation who don’t respond to conservative treatments such as changes in diet, exercise and medication may be candidates for STARR. All candidates undergo special imaging tests to make sure their symptoms aren’t due to other things such as an intestinal obstruction or small bowel slowing. (Source: Mayo Clinic in Jacksonville: August 2006).