Stapled Transanal Resection Of The Rectum (STARR)
WHAT IS A STARR OPERATION
This stands for “stapled transanal resection of the rectum”. It is an operation performed through the anal canal to remove loose, floppy rectal wall, using a special stapling device.
WHEN IS A STARR PERFORMED?
This operation is performed for patients with obstructed defecation syndrome. Patients with this syndrome commonly have to strain when trying to defecate, get the sensation of incomplete evacuation and may have to insert a finger into the vagina or anal canal to aid defecation.
In Oxford, we sometimes perform a “posterior STARR”, removing the redundant back wall of the rectum in the occasional symptomatic patient in whom this is still not well supported after laparoscopic ventral rectopexy.
WHAT TESTS ARE NECESSARY BEFORE THE OPERATION?
We will need to see you in clinic to assess your symptoms and to perform an examination. Many patients having this operation will need an endoscopic (telescope) test on the bowel. We will also perform studies on the anal sphincter to look at its structure and function (anorectal physiology and ultrasound) and transit studies and a proctogram.
WHAT DOES THE OPERATION INVOLVE?
The operation is performed under general anaesthetic.
The whole procedure is performed through the anus (bottom) so there are no cuts or incisions on the outside.
A crescent shaped piece of loose rectal wall is removed at the front and back using a special stapling device. In patients who have previously had a rectopexy and are having a “posterior STARR”, only the loose tissue at the back of the rectum is removed.
HOW DO I PREPARE FOR THE SURGERY?
The hospital will contact you before your operation to arrange for you to come in for a pre-assessment visit. This normally lasts 30-60 minutes.
At your visit you will have some basic health checks to ensure you are fit for surgery. These may include:
- Blood Pressure
- Urine Analysis
- Electrocardiogram (ECG)
- Medical History Questionaire
- MRSA Screen
The nurse will advise whether you should continue to take any regular medication.
You will also be given instructions about when to stop eating and drinking before your operation, what to bring into hospital with you and when to arrive.
An hour or so before the operation, whilst you are in hospital, you are likely to be given an enema to clear the lower bowel.
WHAT IS THE RECOVERY LIKE AFTER THE SURGERY?
You will usually be in hospital for one to two nights after surgery. It is important you do not get constipated but you do not usually require laxatives. You can shower and bathe after the operation.
You may be fit to drive after 1-2 weeks, return to work after 2-4 weeks but should not do any lifting for at least six weeks.
WHAT ARE THE RESULTS LIKE AFTER THE SURGERY?
Approximately 70-75% of patients will get an improvement in their symptoms of obstructed defaecation. STARR needs to be performed with caution in people with incontinence as there is a risk of making this worse.
WHAT ARE THE RISKS AND SIDE-EFFECTS OF THE SURGERY?
Most patients get urgency after this operation and this is a significant problem in 25-50% of patients. Urgency is the constant sensation of needing to open your bowels and feeling unable to “hold on”. These symptoms can be quite severe in some patients. This may last several months.
Approximately 2-4% of patients get significant bleeding.
Some patients have difficulty passing urine immediately after the procedure, and need a temporary urinary catheter. This usually settles within a couple of days.
New symptoms of incontinence may develop in 5-10% of patients.
There have been very rare reports from other centres of rectovaginal fistula (an abnormal connection between rectum and vagina) and severe pelvic infections.
Please be advised that the information on this website is not a substitute for professional medical advice, diagnosis or treatment