This timely review by Drs. Pescatori and Gagliardi provides a cautionary note concerning the enthusiastic adoption throughout Europe of the transanal stapled approach both for haemorrhoids and for the operative management of obstructed defaecation. For the coloproctologist reading this burgeoning literature there appear to be two dialogues going on. On the one hand, some are expounding the virtues of a “one operation fits all” approach particularly for evacuatory difficulty, reporting excellent results specifically in rectocele management. Those on the other side of the debate have sounded loud warnings of the sometimes serious and specific complications following transanal rectotomy in particular. They point out that, although some anatomic anomalies can be corrected, these can be replaced by the emergence of “new” and sometimes unique “post-STARR” symptomatology. Units must carry out stricter case selection and have a stronger fidelity of follow-up of serious postoperative morbidity in order to remain interpretable.
Techniques in Coloproctology Vol. 12, Issue 2, p. 136-137