The Impact of Stapled Transanal Rectal Resection in Patients Undergoing Surgery for Internal Rectal Prolapse, Rectocele and Obstructed Defecation Syndrome: Long-term Results From a Single-center Retrospective Study

Background Stapled Trans-Anal Rectal Resection (STARR) has been widely used to treat internal rectal prolapse (IRP), rectocele, and obstructed defecation syndrome (ODS), but concerns remain about its long-term efficacy and complications. This study aimed to analyze outcomes of patients undergoing surgery for IRP, rectocele, and ODS, with a focus on those who had previously undergone STARR. Methods A prospectively maintained database (November 1998 to January 2025) of patients who underwent abdominal and perineal surgery for IRP, with/without rectocele and entero-/sigmoidocele, was retrospectively analyzed. Patients previously treated with STARR were specifically analyzed. Baseline clinical and radiological characteristics, surgical complexity related to the STARR suture, complications, recurrence, ODS, and fecal incontinence scores were collected. Results Of 376 patients, 50 (13.3%, all female) with prior STARR underwent surgery for IRP, rectocele, and ODS recurrence. Defecography documented IRP and rectocele in 42 (85.7%, median rectocele size: 40.0 mm) patients and entero-/sigmoidocele in 33 (67.3%). Forty-five patients underwent abdominal procedures, five underwent perineal procedures. The STARR suture could not be safely overcome in three cases. At last follow-up (median: 53 months), recurrence occurred in 5.9% of cases, with comparable rates between groups (4.8% vs. 6.1%). One patient experienced persistent pelvic pain related to the STARR suture despite anatomical correction. Overall, ODS and fecal incontinence scores improved, although patients with prior STARR had higher preoperative and postoperative ODS scores. Conclusions Surgery for IRP, rectocele, and ODS recurrence after STARR is feasible yet challenging. Despite study limitations, prior STARR surgery has been associated with more severe preoperative and postoperative ODS symptoms.