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Perineal Stapled Rectal Prolapse Resection in Elderly Patients

Long-term Follow-up

Ram, Edward, M.D.; Hoffman, Aviad, M.D.; Goldes, Yuri, M.D.; Rosin, Danny, M.D.; Horesh, Nir, M.D.; Gutman, Mordechai, M.D.; Edden, Yair, M.D.

doi: 10.1097/DCR.0000000000001215
Original Contributions: Benign
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BACKGROUND: Full-thickness rectal prolapse has a significant negative impact on quality of life. The therapeutic options, specifically in elderly patients, are imperfect. Perineal stapled rectal prolapse resection is a novel operation for treating external rectal prolapse. Long-term follow-up following this procedure is lacking. In our study, we report a long-term follow-up of 30 patients, analyzing the long-term recurrence rate, morbidity, and functional outcome.

OBJECTIVE: This study aimed to examine the long-term results of perineal stapled rectal resection in a population unfit for prolonged general anesthesia.

DESIGN: This was a cohort study with a prospective follow-up.

SETTINGS: This study was conducted at a single tertiary referral center.

PATIENTS: Patients undergoing perineal stapled rectal resection from January 2010 to June 2013 were included.

INTERVENTIONS: Perineal stapled rectal prolapse resection was performed.

MAIN OUTCOME MEASURES: The primary outcome measured was prolapse recurrence.

RESULTS: A total of 30 patients underwent the surgical intervention. The median follow-up period was 61 months (range, 37–65). No intraoperative or postoperative complications occurred. Six patients (20%) had recurrent rectal prolapse, and continence was not achieved in any of the patients. Two patients who had recurrence underwent a redo perineal stapled rectal resection.

LIMITATIONS: This study was limited by the small cohort of selected patients.

CONCLUSIONS: Frail patients that can only endure a short procedure under regional anesthesia should be considered for perineal stapled rectal prolapse resection. The lack of mortality and morbidity, specifically in this population, along with the low long-term recurrence rates, make this a favorable surgical alternative. See Video Abstract at

Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Funding/Support: None reported.

Financial Disclosures: None reported.

Edward Ram and Aviad Hoffman contributed equally to this work.

Correspondence: Edward Ram, M.D., Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel. E-mail:

© 2018 The American Society of Colon and Rectal Surgeons