The Importance of Pre-operative Counselling of a STARR Procedure

A STARR procedure is a stapled trans-anal resection of the rectum which is performed in patients with symptoms of obstructed defecation syndrome associated with internal rectal prolapse or rectocele. The procedure is performed under general anaesthetic using a custom-designed circular stapling device. Patients may be considered for this operation if they have ODS symptoms, such as straining at stool, the need to self-digitate, and a sense of incomplete evacuations.

Prior to surgery conservative measures should be instituted and a proctogram (an x-ray looking at anatomy during evacuation) should be undertaken to confirm internal prolapse. An MDT discussion with investigation results should also be undertaken.

According to the ruling in the 2015 case of Montgomery v Lanarkshire Health Board, in order for consent to be adequate, the doctor must take reasonable care to ensure that the patient is aware of any material risks involved in treatment, as well as any reasonable alternative to the treatment. Material risks of a STARR procedure include chronic pain, tenesmus, infection, leakage, and post-operative bleeding. Alternative treatment options include physiotherapy training on evacuatory technique and rectal irrigation. Therefore, it is imperative that before this procedure is undertaken, the patient is advised of the above risks and alternative treatments.

Important Note

This article is intended to raise awareness to clinical risk issues in an effort to reduce incidence recurrence and improve patient safety. This is not intended to be relied upon as advice. Facts have been altered to ensure this case is non-identifiable, albeit clinical learning points remain applicable.