Functional outcome after perineal stapled prolapse resection for external rectal prolapse

Abstract

Background: A 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.

Methods: From 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.

Results: 32 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.

Conclusions: The PSP is an elegant, fast and safe procedure, with good functional results.

Trial registration: ISRCTN68491191.

Figure 1

Fixation. The prolapse was completely pulled out and fixed by Allis clamps. Then the prolapse was axially cut open at three o'clock with a linear stapler.

Figure 2

Separation. Separation of anterior and posterior wall of the prolapse after secondopening with a linear stapler at nine o'clock.

Figure 3

Resection. Resection of the prolapse continuously counterclockwise by the curved Contour^® Transtar^TM and parallel to the dentate line, first anteriorly.

Figure 4

Cartridges. Number of cartridges used in correlation with the specimen weight.

Figure 5

Wexner faecal incontinence score. (continent = 0, most severe incontinence = 20) before (= Pre-PSP) and after stapled perineal prolapse resection (PSP) (= Post-PSP). Horizontal line = median.