External prolapse of the rectum: stapled prolapse resection, not only for older and frail patients

The perineal stapler prolapse resection (PSP-resection) was introduced in 2008 as an option to treat the external prolapse of the rectum, especially for older, frail patients. This study analyses the recurrence rate, functional outcome and morbidity associated with PSP resection in younger and older patients.

From January 2010 to July 2014, 21 consecutive patients undergoing PSP-Resection using the TRANSTAR™ device were prospectively followed. Recurrence rate, quality of life (Patient Assessment of Constipation-Quality of Life [PAC-Qol]) and complications were documented at baseline, 12 and 24 months after operation. Two subgroups of patients were compared to assess the impact of age and comorbidities on outcome.

We included 21 patients (90% female) in the study. The mean age was 64±21 years and the duration of the operation was 49±6 minutes. Total PAC-QoL score improved from 2.0 (SD 0.3) to 0.9 (0.1) after 12 months, but deteriorated to 1.2 (0.1) after 24 months (P<0.001 for both comparisons). No major complications or mortality were seen. After one year, we had two prolapse recurrences and after 24 months we had also two. There was no significant difference in the outcome concerning the 9 patients being under 50 years old (41±9) compared to the 12 patients over 50 years (81±4).

The PSP-resection seems to be a safe and fast therapeutic option not only for older, frail patients with external rectal prolapse. Also younger people profit from this operative procedure, avoiding the possible major complications of the laparoscopic approach.