title: Primary and repeated perineal stapled prolapse resection.
abstract: BACKGROUND
  Previous studies of the outcome after perineal stapled prolapse resection (PSPR) have included a limited number of patients with a short follow-up and high recurrence rates. The present study was designed to assess the initial results, complications, recurrence rate, and outcomes up to 4 years after PSPR, as well as the need for a repeated procedure.
  
  
  METHODS
  Fifty-four consecutive patients with rectal prolapse (mean age 77.2 years, range 46-93 years; n = 3 men) were selected for PSPR between May 2009 and February 2015. Prolapse length was measured at baseline and after surgery. Patients were asked to grade intensity of symptoms as a satisfaction score of 1-10, 10 representing being symptom-free.
  
  
  RESULTS
  The mean operation time was 45.3 min (SD = 17.5, range 25-95 min). The mean rectal prolapse length was reduced significantly from 9.5 cm (SD = 5.0, range 4-30 cm) to 1.2 cm (SD = 2.6, range 0-10 cm; p < 0.0001). Bleeding requiring surgical intervention occurred in two patients (3.7%). Postoperative satisfaction score increased from a mean of 2.2 (SD = 0.9) to a mean of 6.4 (SD = 2.8, p ≤ 0.0001). After a mean follow-up of 13.4 months (SD = 14.1), six patients with recurrence underwent a new PSPR and five patients underwent colostomy, mainly because of incontinence, resulting in a recurrence rate of 20.4%. There were no complications after redo PSPR, and after a median of 10-month follow-up (range 6-37), there were no recurrences.
  
  
  CONCLUSIONS
  PSPR is a rather new surgical procedure for external rectal prolapse. Immediate complications are few and not serious. Although recurrences can be treated with a second PSPR, the operation may only be the best option for old and fragile patients with comorbidities and a short life expectancy.
authors.affiliation: Department of Surgery, North Zealand Hospital, Copenhagen University, 3400, Hillerød, Denmark. dr.dr@dadlnet.dk.
authors.forename: D
authors.initials: D
authors.lastname: Raahave
authors.affiliation: Section of Biostatistics, Institute of Public Health, Copenhagen University, Copenhagen, Denmark.
authors.forename: A K
authors.initials: AK
authors.lastname: Jensen
authors.affiliation: Department of Surgery, North Zealand Hospital, Copenhagen University, 3400, Hillerød, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Dammegaard
authors.affiliation: Department of Surgery, North Zealand Hospital, Copenhagen University, 3400, Hillerød, Denmark.
authors.forename: I K
authors.initials: IK
authors.lastname: Pedersen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010502:Perineum / Q000601:surgery*; D012005:Rectal Prolapse / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data*; D017792:Surgical Stapling / Q000379:methods / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome
keywords: External rectal prolapse; Perineal approach; Perineal stapled prolapse resection; Rectopexy