Perineal stapled prolapse resection: A csse report

Abstract

Introduction. Over 100 different surgical procedures for the treatment of rectal prolapse have been described. Since these patients commonly have associated comorbidities, methods of choice include surgical techniques with a perineal approach, such as perineal stapled rectal resection. Case Report. A 77-year-old female patient presented with a complete rectal prolapse measuring 12 cm in length. Considering the associated comorbidities and the patient?s age, perineal stapled rectal resection was chosen as the surgical modality. She underwent surgery under general anesthesia in the dorsal decubitus and slightly reverse-Trendelenburg position. The surgery lasted 35 minutes. The surgery and the immediate postoperative course were uneventful. At the follow-up examination, six months after surgery, the findings were normal, without local recurrence. There was a slight deterioration of fecal incontinence, with a Vaizey score 10/20, but the patient tolerated it well. Discussion. The perineal stapled rectal resection technique has fewer intraoperative complications and 6.3% fewer postoperative complications compared to classic perineal procedures (staple line bleeding, anastomotic stenosis, pelvic hematoma, sigmoid colon perforation, perirectal abscesses and rectovaginal fistulas), which were reported in many studies. However, patients with longer postoperative followup demonstrated a higher recurrence rate compared to patients who underwent other surgical techniques with an abdominal approach. Conclusion. The perineal stapled rectal resection procedure is easy to perform and acceptable for the elderly patients with associated comorbidities, who are not candidates for other surgical techniques with abdominal approach.