Comparative clinical outcomes of ventral rectopexy versus STARR in the management of obstructed defecation syndrome: a clinical review.

Abstract

Obstructed defecation syndrome (ODS) is a multifactorial pelvic floor disorder commonly affecting women, characterized by straining, incomplete evacuation, and dependence on manual maneuvers. Among various surgical options, stapled transanal rectal resection (STARR) and laparoscopic or robotic ventral mesh rectopexy (LVMR/RVMR) are frequently employed. However, the comparative effectiveness of these procedures remains debated. This narrative review synthesizes evidence from 43 studies including randomized trials, cohort studies, registries, and systematic reviews published between 2004 and 2025. Clinical outcomes assessed include symptom relief, recurrence, quality of life (QoL), complications, and cost-effectiveness. The methodological quality of included studies was evaluated using the SANRA tool. Both STARR and LVMR/RVMR provide significant early symptom relief in ODS. STARR shows 70-90% short-term improvement, but recurrence rates up to 40% have been reported at 10 years. LVMR achieves durable functional outcomes with recurrence rates < 10%, superior QoL metrics, and fewer anatomical relapses. Mesh-related complications after LVMR are rare (~ 1.4%), but require long-term monitoring. Economically, while STARR has lower initial costs, LVMR/RVMR demonstrates greater long-term cost-effectiveness due to reduced reoperations. RVMR may enhance surgical precision, but increases upfront expenses. STARR remains a valid option for isolated rectocele or low-grade intussusception, whereas LVMR/RVMR is preferable for complex pelvic floor dysfunction. Current evidence favors ventral rectopexy for sustained outcomes, although methodological heterogeneity limits definitive conclusions. Prospective, standardized, long-term comparative trials are essential to optimize surgical strategies for ODS.