Perineal stapled prolapse resection for external rectal prolapse: a systematic review and meta‐analysis

Abstract

Aim Rectal prolapse is an uncommon but debilitating pelvic floor disorder that significantly decreases the quality of life of affected patients. Perineal stapled prolapse resection is a relatively new perineal approach that offers an promising alternative technique in the surgical management of rectal prolapse. It appears to be a simple, reproducible and efficient method. However, longterm outcomes are limited. The aims of this review are to assess the safety and effectiveness of perineal stapled prolapse resection in the management of rectal prolapse. Method A systematic review of all articles describing this approach was searched using MEDLINE, Embase, PubMed, Cochrane, Scopus, Web of Science and China National Knowledge Infrastructure. Included in this review were all randomized and nonrandomized prospective and retrospective studies reporting patients (aged 16 years and older) with complete rectal prolapse who underwent perineal stapled prolapse resection for the surgical treatment of the rectal prolapse. Results A total of 408 patients across 20 articles were included. There were 58 cases of recurrence out of 368 patients over a median length of follow-up of 18 months (interquartile range 12-34 months). The total weighted overall recurrence was 12%. There were 51 cases of postoperative complications in 350 cases, bleeding being the most common complication. Conclusion The recurrence rate is comparable to those of the well-established Altemeier and Delorme procedures. However, given the heterogeneity of studies and variations in lengths of follow-up, further randomized prospective studies are needed to adequately compare this technique against other procedures for complete rectal prolapse.

Perineal stapled prolapse resection in combination with Thiersch operation for relapsed rectal prolapse: a case report

“…Scherer et al reported that, in 14 of 15 patients (93%), perineal stapled prolapse resection was successfully performed without complications, and the median operating time was 33 min (range: 22–52 min) [ 11 ]. Fan et al reported that, in a systematic review of 408 patients who underwent perineal stapled prolapse resection, bleeding was the most common complication, and the total complication rate was 14.5% (51/350) [ 12 ]. However, in a recent systematic review, the median incidence of recurrence was 13.9% for perineal stapled prolapse resection, which was higher than that of the Altemeier procedure (11.4%) [ 10 ].…”

Perineal stapled prolapse resection (PSPR) for full thickness external large rectal prolapse in a frail elderly patient; An easy to teach and reproducible novel technique – a video vignette

“…It appears to be a technically simple, reproducible and efficient method. However, there are limited published data on its long term clinical outcomes and failure rates [2], and the recurrence rate is comparable to other well-established techniques such as Altemeier's and Delorme's procedures [1,4].…”

“…External rectal prolapse is a rare condition, which is more common in older and multi-morbid women with a debilitating pelvic floor disorder that significantly decreases the quality of life of affected patients [1,2]. The estimated adult prevalence of rectal prolapse is 1% in those aged 65 years and greater [1].…”

“…External rectal prolapse is a rare condition, which is more common in older and multi-morbid women with a debilitating pelvic floor disorder that significantly decreases the quality of life of affected patients [1,2]. The estimated adult prevalence of rectal prolapse is 1% in those aged 65 years and greater [1]. Perineal stapled prolapse resection (PSPR) is a relatively new and novel perineal approach that offers an alternative promising technique in the surgical management of rectal prolapse [2,3].…”

Transanal rectopexy for external rectal prolapse

“…Perineal procedures are often reserved for those patients presenting with FTRP who are elderly or who have significant comorbidities [14]. Alternative approaches have included the Delorme mucosectomy, Altemeier's perineal rectosigmoidectomy, and more recently, stapled prolapse resection [15][16][17]. We report the outcomes of a cohort of patients presenting with FTRP who were managed with a transanal sacral rectopexy supplemented by ultrasonographically-guided sclerosant (sodium tetradecyl sulfate plus polidocanol) injected into the retrorectal space.…”