STARR PROCEDURE

Rectal prolapse is a common ailment in elderly patients with predominance among females. Rectal is diagnosed when either a layer of rectum (mucosa)or all the layers of rectum protrude through the anus and visible.

Rectal prolapse usually presents with difficulty in defecation, fecal incontinence, rectal bleeding, mucosal discharge and very rarely without any symptoms.

The rectal prolapse have different gradation and several methods of interpretation is available in literature. The commonly used gradation is

  • GRADE I: Nonrelaxation of the sphincter mechanism(animus)
  • Grade ii: Mild intussusceptions
  • Grade iii: Moderate intussusceptions
  • Grade iv: Severe intussusceptions
  • Grade v: Rectal prolapse

Rectal Prolapse can be classified full thickness(complete), where all the layers of the rectal wall prolapse, or involve the mucosal layer only(partial). External if they protrude from the anus and are visible externally, or internal if they do not. Only Circumferential, where the whole circumference of the rectal wall prolapses, or segmental if only parts of the circumference of the rectal wall prolapse. Present at rest, or occurring during straining.

SURGICAL TREATMENTS

He actively participates in clinical research trials and has been published in peer reviewed journals such as the Journal of the State Medical Society and Baylor University Medical Center’s Proceedings. At Hahnemann Hospital in conjunction with Drexel University, where he received extensive training in coronary as well as peripheral interventions and limb salvage procedures.

Rectal Prolapse surgery is performed to prevent the descent of rectum through the anal canal. The oldest procedure is named after Thiersch. This procedure is performed in elderly patients unfit for anesthesia. This is a simple procedure and can be performed under local anesthesia.

The other procedures like Delorme procedure, Altemeyer procedure, Gant-Miwa procedure are complex in nature and performed rarely because of associated long-term recovery and post –operative morbidity.

The best result of Rectal Prolapse surgery are achieved by abdominal approach and use of prosthetic materials. Rectal prolapse surgery through abdominal root are named after Cutait, Ripstein, Mc Mahan (modified Ripstein).

Resection of redundant prolapsing rectum through abdominal approach, however has been documented are the most successful procedure for rectal prolapse.

After the advent of Laparoscopic procedure Rectal Prolapse surgery is performed with minimal invasion, least post-operative pain, Reduced post-operative morbidity. However Rectal Prolapse surgery by Laparoscopic Requires through knowledge and understanding of Pelvic Anatomy, and highest degree of precision, skill intra corporeal suturing and knotting technique. The Laparoscopic approach for Rectal Prolapse surgery has the advantage of reduced post-operative pain, Shorter hospital stay, Early return to work, without compromising the results compared to other procedure.

The technical evolution in the 21st century with a goal to minimize post-operative pain. Encouraged the discovery of the surgical stapler. Though it was primarily devised for Hemorrhoids(piles), was used for Mucosal prolapse of rectum. This procedure is known as STARR procedure.

STARR (Stapled trans anal Rectal resection) procedure for Rectal Prolapse surgery requires proper patient selection, Evaluation and skilled surgical intuition and accuracy. Starr Procedure for Rectal Prolapse in set of patients selected correctly gives excellent results and can be perform as a Day-care surgery.