The Negative Impact of Stapled Transanal Rectal Resection Procedure in Patients Who Underwent Surgery for Recurrence of Internal Rectal Prolapse, Rectocele and Obstructed Defecation Syndrome: Results of a Long-Term Single-Center Experience

Background Although Stapled Trans-Anal Rectal Resection (STARR) was initially met with significant enthusiasm in the treatment of internal rectal prolapse (IRP), rectocele, and obstructed defecation syndrome (ODS), growing evidence has raised concerns about its long-term efficacy and the risk of serious complications. The aim of the study was to analyze patients who underwent surgery for IRP, rectocele, and ODS recurrence following STARR procedure. Methods Patients who underwent abdominal and perineal surgery for IRP with/without rectocele and entero/sigmoidocele between November 1998 and January 2025 were included. Those previously treated with STARR were specifically analyzed. Baseline clinical and radiological characteristics, surgical complexity related to STARR suture, complications, recurrence, ODS and fecal incontinence scores were collected. Results Out of 376 patients, 50 females (13.3%) with previous STARR surgery underwent surgery for IRP, rectocele, and ODS recurrence. At defecography, IRP and rectocele were both detected in 42 of the 50 STARR patients [84.0%, median rectocele size: 40(28–50) mm]. Entero/sigmoidocele was found in 33 cases (66.0%). Forty-five patients had abdominal procedures and five underwent perineal techniques. STARR suture could not be safely overcome in three cases. At a median follow-up of 53(14–115) months, recurrence occurred in 5.9% of cases, with comparable rates in both groups (4.8% vs. 6.1%). One patient experienced persistent chronic pelvic pain due to STARR suture despite anatomical correction. Overall, ODS and fecal incontinence scores significantly improved; however, patients with prior STARR showed higher preoperative and postoperative ODS scores. Conclusions Surgery for IRP, rectocele, and ODS recurrence after STARR is feasible but challenging. Long-term results showed that previous STARR is linked to more severe ODS symptoms and less functional improvement. STARR could be unsuccessful and complicate further surgeries.