STARR procedure

A digital-rectal examination is performed to validate the findings and a careful digital anal dilation. In the rectal-digital examination, the rectocele can be palpated ventrally, the vaginal posterior wall bulges forward during palpation. The extent of the rectoanal intussusception is assessed with the swab on a stick and/or an Allis clamp. Subsequently, careful digital dilation of the anal sphincter is performed before the anal dilator is inserted. Then, the transparent proctoscope is introduced into the anal canal as an anal port and to protect the anoderm.

Tip

The transparent proctoscope (anal port) can be temporarily fixed to the perianal skin with four stitches.

After insertion of the 3/4 anoscope, the placement of the semicircular purse-string suture (non-absorbable monofilament thread of size 0/0 or 2/0) is performed. Depending on the extent of the prolapse, 2-3 semicircular purse-string sutures can also be placed. The semicircular suture is placed at least 2 cm above the hemorrhoidal zone from approximately 9 to 3 o'clock SSL, whereby, in contrast to stapled hemorrhoidectomy, not only the mucosa but the full wall of the rectum is pierced. Subsequently, the first digital control of the posterior vaginal wall is performed.

Tip

Alternatively, the rectal wall at 2-3, 12 and 9 o'clock SSL can be grasped with one overhand stitched suture each, which is knotted.