Complications - STARR — Stapled TransAnal Rectal Resection

• Parts of the anal canal inadvertently caught in the resection

→ careful placement of the anal port

• Incomplete closure of the stapled suture line

→interrupted sutures of the rectal wall with Vicryl 3/0

• Bleeding at the stapled suture line

→ suture ligation of bleeders with Vicryl 2/0

• Posterior vaginal wall caught after placement of the Prolene sutures

→ Remove the sutures and re-place them while sparingly including rectal wall.

• Injury to the small intestine prolapsed into the rectovaginal space

→ Place the Prolene sutures with the patient in Trendelenburg position; palpate the vagina before total closure of the stapler.

• Secondary bleeding (up to 5%)
• Septic complications also necrotizing fasciitis (up to 4.4%)
• Persistent pain (up to 7%)
• Fecal urgency (up to 20%)
• Urinary retention (up to 7%)
• Suture line failure (up to 3.5%)
• Fecal incontinence (up to 1.8%)
• Recurrent intussusception and/or obstructive defecation syndrome (5–18.7%)
• Rectovaginal fistula and rectal wall necrosis (rare)

→ staged loop ileostomy: Fistula closure with graciloplasty, if needed.