Perineal Stapled Prolapse Resection for Complete External Rectal Prolapse: Preliminary Experience and Literature Review

Abstract

Purpose: Perineal stapled prolapse resection (PSP) for external rectal prolapse is a new surgical technique. Methods: Between April 2009 and January 2011, 5 female patients (mean age, 67 years; range, 53–76) underwent PSP for full-thickness external rectal prolapse. Patients were placed in a slight Trendelenburg position to free the pouch of Douglas from any deep enterocele. Laparoscopic control of the PSP procedure was performed to avoid injury to the bowel in one patient with anorexia. The prolapse was completely resected continuously counterclockwise using a curved Contour® Transtar™ stapler placed parallel to the dentate line. After completion of resection, the neorectum fell back into place spontaneously. Results: Mean operating time was 56 min (range, 40–90). No intraoperative or postoperative complications occurred. No recurrence appeared. The mean hospital stay was 4 days (range, 3–6); the mean follow-up was 6.5 months (range, 2–15). The mean Wexner fecal incontinence score was 9.2 before and 4.6 at 3 months after surgery (p = 0.010); the mean obstructed defecation syndrome score decreased from 16 to 4.75 (p < 0.001). Conclusions: PSP is an easy, fast and safe procedure. Early functional results are good. Long-term results and recurrence rates need to be investigated further.