title: Perineal stapled prolapse resection for external rectal prolapse: is it worthwhile in the long-term?
abstract: BACKGROUND
  Perineal stapled prolapse (PSP) resection is a novel operation for treating external rectal prolapse. However, no long-term results have been reported in the literature. This study analyses the long-term recurrence rate, functional outcome, and morbidity associated with PSP resection.
  
  
  METHODS
  Nine consecutive patients undergoing PSP resection between 2007 and 2011 were prospectively followed. Surgery was performed by the same surgeons in a standardised technique. Recurrence rate, functional outcome, and complication grade were prospectively assessed.
  
  
  RESULTS
  All 9 patients undergoing PSP resection were investigated. The median age was 72 years (range 25-88 years). No intraoperative complications occurred. Faecal incontinence, preoperatively present in 2 patients, worsened postoperatively in one patient (Vaizey 18-22). One patient developed new-onset faecal incontinence (Vaizey 18). The median obstructive defecation syndrome score decreased postoperatively significantly from 11 (median; range 8-13) to 5 (median; range 4-8) (p < 0.005). At a median follow-up of 40 months (range 14-58 months), the prolapse recurrence rate was 44 % (4/9 patients).
  
  
  CONCLUSIONS
  The PSP resection is a fast and safe procedure associated with low morbidity. However, the poor long-term functional outcome and the recurrence rate of 44 % warrant a cautious patient selection.
authors.affiliation: Clinic for Visceral and Transplantation Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Tschuor
authors.forename: P
authors.initials: P
authors.lastname: Limani
authors.forename: A
authors.initials: A
authors.lastname: Nocito
authors.forename: D
authors.initials: D
authors.lastname: Dindo
authors.forename: P-A
authors.initials: PA
authors.lastname: Clavien
authors.forename: D
authors.initials: D
authors.lastname: Hahnloser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005242:Fecal Incontinence / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D061214:Patient Safety; D010502:Perineum / Q000601:surgery; D011351:Proctoscopy / Q000379:methods*; D011446:Prospective Studies; D012005:Rectal Prolapse / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D018570:Risk Assessment; D012720:Severity of Illness Index; D017792:Surgical Stapling / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome