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Midterm Results After Perineal Stapled Prolapse Resection for External Rectal Prolapse

Sehmer, Diana M.D.1; Marti, Lukas M.D.2; Wolff, Katja M.D.2; Hetzer, Franc H. M.D.1

Diseases of the Colon & Rectum: January 2013 - Volume 56 - Issue 1 - p 91–96
doi: 10.1097/DCR.0b013e31826cbbea
Original Contribution: Benign Colorectal Disease

BACKGROUND: Previous studies showed that perineal stapled prolapse resection for external rectal prolapse improves continence and has short operation times and low complication rates.

OBJECTIVE: The aim of this study was to assess the midterm recurrence rates, functional results, and patient satisfaction after perineal stapled prolapse resection.

DESIGN: This was a retrospective study.

SETTINGS: The study was performed at a tertiary hospital in Switzerland.

PATIENTS: From November 2007 to October 2011, a total of 56 consecutive patients were included in the study.

MAIN OUTCOME MEASURES: Recurrence rates, functional results according to the Wexner incontinence scale, and patient satisfaction using a visual analog scale were determined

RESULTS: The median age was 78.5 years (range, 24–94 years), and 2 patients were men. Midterm results were available for 46 (82%) of 56 patients after a median follow-up of 25.5 months (range, 2–47 months). In 10 cases (18%) data collection was not possible. The recurrence rate at 3 years was 19.7% (95% CI 4.2%–32.7%). The Wexner incontinence score improved from a median of 14.5 presurgery to 4.0 points (p < 0.0001) after surgery. Twenty-five patients (54%) stated that their bowel movements were regular postoperatively. On a visual analog scale that measured satisfaction, the median patient score was 9 (range, 0–10), indicating high patient satisfaction.

LIMITATIONS: Limitations included the retrospective study design and the lack of clinical examinations to determine recurrence rates.

CONCLUSIONS: Perineal stapled prolapse resection is an alternative technique for treating rectal prolapse with a recurrence rate similar to the Altemeier-Mikulicz or Delorme procedures. This technique is a quick and reliable procedure for use in patients with advanced age.

1 Clinic of Surgery, Cantonal Hospital, Schaffhausen, Switzerland

2 Department of Surgery, Cantonal Hospital, St Gallen, Switzerland

Financial Disclosure: Drs Hetzer and Marti are paid consultants of Ethicon Endo-Surgery for stapled transanal rectal resection (STARR) with Contour Transtar, but they are not associated with Ethicon Endo-Surgery for the perineal stapled prolapse resection (PSP) technique used in this study. Ethicon Endo-Surgery was not involved in the study.

Correspondence: Franc H. Hetzer, M.D., Clinic of Surgery, Cantonal Hospital Schaffhausen, Geissbergstrasse 81, CH-8208 Schaffhausen, Switzerland. E-mail: franc.hetzer@spitaeler-sh.ch

© The ASCRS 2013