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Date issued: May 2015

For review:  May 2017

Ref: B-335/AC/Medicine/STARR

PDF:  STARR [pdf] 292KB


What is a STARR?

This stands for ‘stapled transanal resection of the rectum’. It is an operation performed through the anal canal (back passage) to remove loose, floppy rectal wall, using a special stapling device.


When is a STARR performed?

This operation is performed for patients with Obstructive Defaecation Syndrome (ODS). Patients with this syndrome commonly have to strain when trying to defaecate, get the sensation of incomplete evacuation and may have to insert a finger into the vagina or anal canal to help defaecation. ODS often happens because of changes in the structure of the rectum. For example, the lining of the rectum may slide out of place – this is called a prolapse. Or the rectum itself may slide inside itself (the medical term for this is intussusception). Finally the rectum may bulge into the vagina (rectocele).


What other tests will I need 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 the structure and function (anorectal physiology and ultrasound) 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 that 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.


What is the recovery like after surgery?

You will usually be in hospital for 1-2 nights after surgery. It is important you do not get constipated but you do not usually require laxatives. You can shower and bath after the operation. You may be fit to drive after 1-2 weeks, return to work after 2-4 weeks but should not try to do any lifting for at last 6 weeks.


What are the results like from surgery?

Approximately 70-75% of patients will get an improvement in their symptoms of obstructive defaecation. STARR needs to be performed with caution in people with incontinence as there is a risk of making this worse. There are a number of risks and side effects from surgery, listed below.


What are the risks of surgery?

Most patients get urgency after this operation and this is a significant problem for 25-50% of patients that may last several months. Urgency is constant sensation of needing to open your bowels and feeling unable to ‘hold on’. These symptoms can be quite sincere in some patients.

Approximately 2-4% of patients get significant bleeding. Some patients have difficulty passing urine immediately after the procedure necessitating a temporary urinary catheter. This usually settles within a couple of days. New symptoms of incontinence may develop in 5-10% of patients. Other complications could include perforation of the bowel, inflammation of the membrane that lines the abdominal cavity and covers the organs in the abdomen (called peritonitis) and pelvic infection.

Diagram showing the redundant (floppy) recal wall lining, known as an intussusception (shown in red on the diagram). The area is excised in a STARR operation and the bowel edges held together with staples.


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