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An Orlando medical group, the Colon and Rectal Clinic (CRC), was selected by the inventor of a new surgical device to perform clinical trials for a novel procedure to alleviate symptoms of Obstructed Defecation Syndrome (ODS) during the device’s prerelease clinical studies.

Physicians at Orlando’s CRC, along with surgeons at the Cleveland Clinic in Ohio, were selected to administer pre-release clinical studies to test the efficacy of the procedure and the stapling device.

Physicians from the CRC, who serve as faculty for Ethicon Endo-Surgery, are now teaching other physicians across the country to use the stapling device in a procedure called Stapled Transanal Rectal Resection (STARR) via nationwide videoconferencing through the Orlando Regional Medical Center.

Dr. Joseph T. Gallagher of the CRC said the STARR procedure improves the quality of life for people who have had difficulty in long term constipation and evacuation. The minimally invasive surgical approach requires no external incisions and leaves no visible scars, and provides decreased pain and improved recovery time compared to traditional rectocele repairs.

In a study of 90 patients undergoing the STARR procedure, CRC physicians found patients were hospitalized one to three days, experienced minimal postoperative pain after the procedure, and resumed employment or normal activity within two weeks.

Using a surgical stapler developed in Vienna, the procedure removes excess tissue, and reduces the deformities that can cause ODS.

Physicians at CRC are advocates of the STARR device, now on the market for the United States, which showed substantially reduced symptoms for patients enrolled in the clinical study they conducted. The CRC studies show that most ODS patients experienced a significant improvement in their ODS symptoms following STARR.

ODS is a form of chronic constipation that affects thousands of people, primarily women, in the United States. It is usually treated with traditional changes in diet, exercise and medication but sometimes requires a surgical intervention. It is estimated that 16 percent of women in the United States have symptoms that meet the medical criteria for constipation. It results in more than 2.5 million visits to physicians, 92,000 hospitalizations and laxative sales of several hundred million dollars.

Women suffering from ODS have had two or more children and may have experienced difficulties or were injured during childbirth, traumas that can damage the muscles that separate the vaginal wall from the anal canal. Sometimes, structural deformities within the rectum or anus also contribute to the condition. Diagnosis can be complex and requires evaluation by a primary care physician, gastroenterologist and colorectal surgeon to be sure the actual causes of the disorder are identified.

A videoconference suite was developed at Orlando Regional Medical Center to enable physicians to teleconference surgeries, and physicians at the CRC, which has a downtown campus just a few blocks from ORMC, have been involved in teaching physicians across the country via this medium.

On June 12, Dr. Samuel DeJesus performed two STARR surgeries, for the first time teleconferencing the procedure to multiple sites. Gallagher from CRC traveled to Cincinnati to moderate the surgeries as they were broadcast to physicians and program administrators attending a course on the procedure, as DeJesus performed the surgeries in Orlando. The procedure was also teleconferenced to medical centers in New Jersey, Nebraska, Maryland, Dallas and Boston.

“Our physicians were pleased to be able to share their skills on procedures like STARR nationwide via videoconferencing and with residents in the medical education programs at Orlando Regional,” said Nancy Joiner, administrator of education and research at CRC. “It’s a definitive advantage to have the technology available to us that ORMC provides that allows us to contribute to the education of future specialists in the field of colon and rectal medicine.”



December 2007

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