Comments on Midterm Results After Perineal Stapled Prolapse Resection for External Rectal Prolapse

To the Editor—We have read with great interest the recent article by Sehmer et al,1 who presented their experience in the treatment of complete external rectal prolapse with perineal stapled prolapse resection (PSP); they reported their results with the use of the original2 and the modified3 technique. The authors refer to a median follow-up of 25.5 months and a recurrence rate at 3 years of 19.7%. It is not clear how many patients completed the 3 years of follow-up. The authors also presented early recurrences at 1, 2, 3, and 11 months. Are these recurrences related to wrong indications or suboptimal surgical technique? Is the length or the thickness of the prolapse important for the choice of PSP with respect to other perineal procedures? Moreover, a telephone interview could underestimate the recurrence rate, and only a rigid proctoscopy could probably value it adequately. Finally, the authors present functional results analyzing bowel movements and incontinence. Could the evaluation of the obstructed defecation syndrome score (Altomare et al4 or Jayne et al5) better reflect functional results? Diarrhea in an older patient, mainly if associated with a complete rectal prolapse, is generally associated with fecal incontinence. Thus, the correction of the prolapse, better if associated with the regulation of diarrhea, is responsible for the reduction of incontinence, more than the surgical technique. We agree6 with the authors that PSP is an alternative technique in the treatment of rectal prolapse, but if the recurrence rate is similar to the Delorme or Altemeier procedures, the cost of the device probably does not justify its use.