Comments on Long-term outcome after transanal rectal resection in patients with obstructed defecation syndrome.

To the Editor—the authors thank Dr francesco saverio mari and his colleagues for commenting on our article in the february 2013 issue of Diseases of the Colon & Rectum. We concur with them that the rate of incontinence that we observed postoperatively was rather high, with a new onset in 13% of patients at 4 weeks after the operation. however, of the 16 patients that reported an impairment of continence initially, only 3 (4%) remained incontinent at the end of follow-up. in many patients, continence was restored solely by reducing the laxatives that had been taken since before the operation. the rate of incontinence and how this is measured differs in the literature. other authors report persisting incontinence problems of up to 10% of their patients after more than 1 year after the operation. the development of incontinence after a staRR operation is therefore a serious problem, and patients should be carefully informed about this specific complication before giving their consent. We agree that a thorough preoperative evaluation is crucial to selecting the right patients for the staRR procedure. our patients were investigated profoundly and selected carefully according to the guidelines of the staRR pioneers, as we stated. this included routine anal manometry. all the same, even with such investigations, a new onset of postoperative incontinence cannot be avoided completely. furthermore, some desperate cases with already preexisting incontinence and additional obstructed defecation problems were included in our series. the staRR procedure helped most of those patients, but, in some cases, only after a second, previously anticipated procedure (eg, sacral neuromodulation) was performed. other authors also have reported Comments on Long-term Outcome After Transanal Rectal Resection in Patients With Obstructed Defecation Syndrome