Perineal stapled prolapse resection for full thickness rectal prolapse

BackgroundExternal rectal prolapse has an incidence of approximately 0.5% and is associated with negative consequences for the quality of life, especially concerning fecal incontinence. Women are affected by rectal prolapse 6times as often as men and besides female sex, other risk factors are ahigh number of vaginal births, old age, high body mass index (BMI) and constipation. This article presents anew perineal surgical procedure, the perineal stapled resection and report the experiences with the technique from published results.Material and methodsThe perineal stapled prolapse resection (PSPR) is performed with the patient in a lithotomy position and can be done under general or spinal anesthesia. The rectal prolapse is axially cut open at the 3o'clock and 9o'clock positions with alinear stapler. The staple line ends 1-2cm from the dentate line on both sides. Subsequently, the prolapse is resected continuously counterclockwise with acurved stapler (Contour-Transtar) and parallel to the dentate line, first anteriorly starting at 3o'clock position and second posteriorly beginning at 9o'clock. For safe hemostasis the stapled sutures must be covered by simple interrupted sutures.ResultsIn the published case series, the PSPR procedure is described as quick and simple. The morbidity is estimated to be low, which is particularly suitable for older multimorbid patients. In the published studies the recurrence rate of aprolapse is approximately 18% which is comparable to the other perineal procedures, such as the Delormes or Altemeier techniques.