title: Stapled transanal rectal resection in solitary rectal ulcer associated with prolapse of the rectum: a prospective study.
abstract: OBJECTIVE
  At present, none of the conventional surgical treatments of solitary rectal ulcer associated with internal rectal prolapse seems to be satisfactory because of the high incidence of recurrence. The stapled transanal rectal resection has been demonstrated to successfully cure patients with internal rectal prolapse associated with rectocele, or prolapsed hemorrhoids. This prospective study was designed to evaluate the short-term and long-term results of stapled transanal rectal resection in patients affected by solitary rectal ulcer associated with internal rectal prolapse and nonresponders to biofeedback therapy.
  
  
  METHODS
  Fourteen patients were selected on the basis of validated constipation and continence scorings, clinical examination, anorectal manometry, defecography, and colonoscopy and were submitted to biofeedback therapy. Ten nonresponders were operated on and followed up with incidence of failure, defined as no improvement of symptoms and/or recurrence of rectal ulceration, as the primary outcome measure. Operative time, hospital stay, postoperative pain, time to return to normal activity, overall patient satisfaction index, and presence of residual rectal prolapse also were evaluated.
  
  
  RESULTS
  At a mean follow-up of 27.2 (range, 24-34) months, symptoms significantly improved, with 80 percent of excellent/good results and none of the ten operated patients showed a recurrence of rectal ulcer. Operative time, hospital stay, and time to return to normal activity were similar to those reported after stapled transanal rectal resection for obstructed defecation, whereas postoperative pain was slightly higher. One patient complained of perineal abscess, requiring surgery.
  
  
  CONCLUSIONS
  The stapled transanal rectal resection is safe and effective in the cure of solitary rectal ulcer associated with internal rectal prolapse, with minimal complications and no recurrences after two years. Randomized trials with sufficient number of patients are necessary to compare the efficacy of stapled transanal rectal resection with the traditional surgical treatments of this rare condition.
authors.affiliation: 1st Department of General Surgery, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, IRCCS Foundation, Milan, and the University of Milan, Milan, Italy. pboccasanta@policlinico.mi.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Boccasanta
authors.forename: Marco
authors.initials: M
authors.lastname: Venturi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Calabro
authors.forename: Marco
authors.initials: M
authors.lastname: Maciocco
authors.forename: Gian Carlo
authors.initials: GC
authors.lastname: Roviaro
mesh_terms: D001676:Biofeedback, Psychology; D019841:Defecography; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D012002:Rectal Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D012005:Rectal Prolapse / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D011795:Surveys and Questionnaires; D013537:Sutures; D016896:Treatment Outcome; D014456:Ulcer / Q000150:complications / Q000503:physiopathology / Q000601:surgery*