Perineal stapled prolapse resection: preliminary experience

Background Perineal stapled prolapse resection (PSP) for external rectal prolapse is a new surgical technique initially described by Scherer et al. in 2008. A search of the literature identified 50 patients treated with PSP. Methods We performed PSP in 4 female patients. Mean age was 67 years (range 53–76 years). One patient was affected by multiple sclerosis and another patient had a prior stroke. One prolapse was non-reducible and another one was a recurrence after a Delorme. Results All patients were submitted to PSP procedure. To free the pouch of Douglas from possible enterocele, a slight Trendelemburg position was chosen. In a very thin woman suspected to have enterocele on clinical exam, the procedure was carried out under laparoscopic control. In all cases, the rectal prolapse was put under traction with Ellis clamps and axially opened with a linear stapler at three o’clock in the first case and at three and nine o’clock in all other cases. This was found to reduce the risk of torsion of the prolapse. The linear stapled line ended 1–2 cm from the dentate line. The prolapse was completely resected in a counterclockwise direction with a curved Contour TranstarTM parallel to the dentate line starting at three o’clock. After completing the resection, the anastomotic line spontaneously reduced. Haemostasis was controlled. Mean operative time was 56 min (40–90 min). No intraoperative or postoperative complications occurred. Mean hospital stay was 4 days (range 3–6 days). At mean follow-up was 6.5 months (range 2–15 months), there was no recurrence. Conclusions PSP is a new surgical procedure for external rectal prolapse. It appears easy, fast, and a safe. Early functional results are good. Long-term functional results and recurrence rate must be investigated further.