Circular transanal stapled procedure for incomplete rectal prolapse associated with outlet obstruction versus conventional procedure.
The circular stapled procedure for mucosal prolapse of the rectum takes less time, is a less risky, less painful rectal procedure, and permits the preservation of more mucosa than conventional procedures. We compared retrospectively the early outcome of the circular transanal stapled procedure (n = 13), for incomplete rectal mucosal prolapse associated with outlet obstruction, with the current standard Milligan-Morgan procedure (n = 15). Under spinal anaesthesia, patients underwent a standardised diathermy perianal operation, or had a circumferential doughnut of mucosal prolapse at least 2 cm above the dentate line, using a circular end-to-end stapler (Ethicon Endosurgery SDH 33). All patients received the same preoperative analgesic and laxative regimens. The operating time for the stapled group was shorter (22-58 min, median 38) versus (42-79 min, median 68). The use of analgesics was significantly less, with 85% of the patients not using analgesics on and following the first postoperative day. The hospital stay was significantly shorter for the stapled group (3-5 days, median 3.2 versus 7-14 days, median 12.2). Constipation before procedure was improved in both groups. Early and late complications, and the functional outcome, measured by rectoanal manometry, appeared to be similar in short-term follow-up. However, the long-term results of recurrence, symptomatic and functional outcome, have yet to be evaluated in the extended follow-up.