Functional outcome after perineal stapled prolapse resection for external rectal prolapse

Abstract

BackgroundA new surgical technique, the Perineal Stapled Prolapse resection (PSP) for external rectal prolapse was introduced in a feasibility study in 2008. This study now presents the first results of a larger patient group with functional outcome in a mid-term follow-up.MethodsFrom December 2007 to April 2009 PSP was performed by the same surgeon team on patients with external rectal prolapse. The prolapse was completely pulled out and then axially cut open with a linear stapler at three and nine o'clock in lithotomy position. Finally, the prolapse was resected stepwise with the curved Contour® Transtar™ stapler at the prolapse's uptake. Perioperative morbidity and functional outcome were prospectively measured by appropriate scores.Results32 patients participated in the study; median age was 80 years (range 26-93). No intraoperative complications and 6.3% minor postoperative complications occurred. Median operation time was 30 minutes (15-65), hospital stay 5 days (2-19). Functional outcome data were available in 31 of the patients after a median follow-up of 6 months (4-22). Preoperative severe faecal incontinence disappeared postoperatively in 90% of patients with a reduction of the median Wexner score from 16 (4-20) to 1 (0-14) (P < 0.0001). No new incidence of constipation was reported.ConclusionsThe PSP is an elegant, fast and safe procedure, with good functional results.Trial registrationISRCTN68491191

Perineal Stapled Prolapse Resection

“…Two out of three patients (66 %) improved as regards constipation after surgery and none developed de novo constipation (Table 1). This is in accordance with the PSPR study done by Hetzer et al (Table 2), who also found no new de novo constipation in any of the patients though constipation improved in 16.6 % of patients postoperatively [1,2]. The symptom of constipation continued in one patient postoperatively with some symptomatic improvement.…”

“…One patient continues to have severe incontinence that was managed conservatively with bulk forming agents. The improvement in continence after PSPR is in accordance with the PSPR study done by Hetzer et al (Table 2); in his study, severe fecal incontinence disappeared postoperatively in 90 % of patients [1,2]. Demibras et al [18] (2005) in their series of 40 cases of laparoscopic rectopexy reported improved continence in 71 % of patients.…”

“…A new surgical technique for external rectal prolapse, the perineal stapled prolapse resection (PSPR), was introduced in 2007 [1,2]. The PSPR is completed in 12 patients with no major intraoperative complications in our department.…”

“…Most important advantage of PSPR in comparison to established perineal techniques like Delorme's procedure, perineal rectosigmoidectomy, or perineal rectosigmoidectomy with levatorplasty is short operating time, short hospital stay, and early recovery and equal cost as compared to open surgery [1,2]. The cost of staplers used in PSPR (Rs 20,000-35,000) turns out to be equivalent to cost of mesh (Rs 3000 ), tackers (Rs 18,000), anesthesia charges (higher for GA) and operative charges (higher for laparoscopic procedures) in abdominal surgery for rectal prolapse, though cost involved in abdominal rectopexy is slightly less if suture rectopexy is done.…”

“…A new surgical technique called perineal stapled prolapse resection (PSPR) for external prolapse was described by Roland et al in 2007 and showed good functional results [1,2]. PSPR is being carried out in our department since 2010.…”