Persistent dyschezia after double stapled transanal rectal resection for outlet obstruction: four case reports

Dyschezia, which presents with symptoms of outlet obstruction and difficult defecation including straining, feeling of incomplete evacuation after defecation, and manual manoeuvres to facilitate defecation,1 is sometimes due to an intussusception extending into the anal canal (i.e. recto-anal intussusception) and/or to anterior rectocele. After failed first line medical and/or rehabilitative therapy, both diseases may be treated with surgical repair, but there is little agreement on the best approach. A recent technique, the double stapled trans-anal rectal resection (STARR), has been proposed for obstructed defecation due to recto-anal intussusception and rectocele.2 The first stapler is used anteriorly, to correct rectocele and reduce intussusception, the second stapler is fired posteriorly, to complete the resection of intussusception. In this study we present four cases of failed treatment, i.e. post-operative persistent difficulty in defecation following STARR. The aims of the study were to identify the causes of failure, outline an effective rehabilitative treatment program and evaluate post-rehabilitation results.