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Perineal stapled prolapse resection for external rectal prolapse: is it worthwhile in the long-term?
C Tschuor1, P Limani, A Nocito
1Clinic for Visceral and Transplantation Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Techniques in Coloproctology
|April 25, 2013
Summary
Perineal stapled prolapse (PSP) resection shows low morbidity but a high 44% recurrence rate. Long-term functional outcomes and patient selection require careful consideration for this rectal prolapse treatment.
Area of Science:
- Colorectal surgery
- Surgical innovation
- Pelvic floor disorders
Background:
- Perineal stapled prolapse (PSP) resection is a new surgical approach for external rectal prolapse.
- Limited long-term data exists on the efficacy and safety of PSP resection.
- This study evaluates long-term outcomes, including recurrence, function, and complications.
Purpose of the Study:
- To assess the long-term recurrence rate of external rectal prolapse after PSP resection.
- To evaluate the functional outcomes, including fecal incontinence and obstructive defecation syndrome, post-PSP resection.
- To determine the morbidity associated with the PSP resection procedure.
Main Methods:
- Prospective follow-up of nine consecutive patients who underwent PSP resection between 2007 and 2011.
- Standardized surgical technique performed by experienced surgeons.
- Systematic assessment of prolapse recurrence, functional status (fecal incontinence, obstructive defecation syndrome scores), and complications.
Main Results:
- No intraoperative complications were observed in the nine patients.
- Postoperative fecal incontinence worsened in one patient, and a new case emerged in another.
- Significant reduction in obstructive defecation syndrome scores (median 11 to 5, p < 0.005).
- A high prolapse recurrence rate of 44% (4/9 patients) was observed at a median follow-up of 40 months.
Conclusions:
- PSP resection is a rapid and safe procedure with minimal immediate complications.
- The procedure is associated with a substantial long-term prolapse recurrence rate of 44%.
- Cautious patient selection is recommended due to the high recurrence rate and potential for poor long-term functional outcomes.
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