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Stapled transanal longitudinal posterior proctectomy (STALPP) in total rectal prolapse: a 7-year experience

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Abstract

Background

Surgical management of complete rectal prolapse is challenging. We present our results with the novel technique stapled transanal longitudinal posterior proctectomy (STALPP) in patients with complete rectal prolapse.

Methods

We performed a retrospective study in two hospitals from January 2005 to December 2012. Twenty-one patients with complete rectal prolapse were included. In all patients, STALPP was performed. The study variables were operative time, intraoperative bleeding, number of cartridges used, length of rectum prolapsed through the anus, length of rectal wall resected, length of hospital stay and preoperative and postoperative Wexner continence score and manometric measurement of anal canal resting tone and squeeze pressure.

Results

The median length of prolapsed tissue was 13 cm; the mean Wexner score in the preoperative and postoperative period was 15.95 and 4.95, respectively (p = 0.025). The mean resting tone improved from 23.3 to 32.85 mmHg postoperatively (p = 0.03), as did maximal squeeze pressure from 31 to 62.7 mmHg (p = 0.003). Median operative time was 65 min; median intraoperative bleeding was 12 ml; there was no postoperative bleeding, and no reinterventions were required. The median number of cartridges used was 4. The median length of resected wall in the right posterolateral sector was 8 and 6 cm in the left. The median length of hospital stay was 4 days, and the mean follow-up period was 2 years. No mortality was reported.

Conclusions

Stapled transanal longitudinal posterior proctectomy is a safe and feasible surgical alternative for patients with complete rectal prolapse.

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References

  1. Blas-Franco M, Rangel PJ, Almeraya OJ et al (2008) Surgical management of complete rectal prolapse: open vs minimally invasive surgery complications. Rev Mex Cir Endoscop 9:97–104

    Google Scholar 

  2. Kim DS, Tsang CB, Wong WD, Lowry AC, Goldberg SM, Madoff RD (1999) Complete rectal prolapse: evolution of management and results. Dis Colon Rectum 42:460–466

    Article  CAS  PubMed  Google Scholar 

  3. Altomare DF, Binda GA, Ganio E, De Nardi P, Giamundo P, Pescatori M, Rectal Prolapse Study Group (2009) Long-term outcome of Altemeier’s procedure for rectal prolapse. Dis Colon Rectum 52:698–703

    Article  PubMed  Google Scholar 

  4. Carley ME, Shaffer J (2000) Urinary incontinence and pelvic organ prolapse in women with Marfan or Ehlers Danlos syndrome. Am J Obstet Gynecol 182:1021–1023

    Article  CAS  PubMed  Google Scholar 

  5. Swift S, Woodman P, O’Boyle A et al (2005) Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol 192:795–806

    Article  PubMed  Google Scholar 

  6. Cirocco WC (2010) The Altemeier procedure for rectal prolapse: an operation for all ages. Dis Colon Rectum 53:1618–1623

    Article  PubMed  Google Scholar 

  7. Brown AJ, Anderson JH, McKee RF, Finlay IG (2004) Strategy for selection of type of operation for rectal prolapse based on clinical criteria. Dis Colon Rectum 47:103–107

    Article  CAS  PubMed  Google Scholar 

  8. Pescatori M, Milito G, Fiorino M, Cadeddu F (2009) Complications and reinterventions after surgery for obstructed defecation. Int J Colorectal Dis 24:951–959

    Article  PubMed  Google Scholar 

  9. Corman ML, Carriero A, Hager T et al (2006) Consensus conference on the stapled transanal rectal resection (STARR) for disordered defecation. Colorectal Dis 8:98–101

    Article  CAS  PubMed  Google Scholar 

  10. Sherer R, Marti L, Hetzer FH (2008) Perineal prolapse resection: a new procedure for external rectal prolapse. Dis Colon Rectum 51:1727–1730

    Article  Google Scholar 

  11. Gagliardi G, Pescatori M, Altomare DF et al (2008) Results, outcome predictors, and complications after stapled transanal rectal resection for obstructed defecation. Dis Colon Rectum 51:186–195

    Article  PubMed  Google Scholar 

  12. Ho YH, Tsang C, Tang CL, Nyam D, Eu KW, Seow-Choen F (2000) Anal sphincter injuries from stapling instruments introduced transanally: randomized controlled study with endoanal ultrasound and anorectal manometry. Dis Colon Rectum 43:169–173

    Article  CAS  PubMed  Google Scholar 

  13. Arroyo A, Pérez-Vincente F, Serrano P et al (2007) Evaluation of stapled transanal rectal resection technique with two staplers in the treatment of obstructive defecation syndrome. J Am Coll Surg 204:56–63

    Article  PubMed  Google Scholar 

  14. Stuto A, Renzi A, Carriero A et al (2011) Stapled trans-anal rectal resection (STARR) in the surgical treatment of the obstructed defecation syndrome: results of STARR Italian registry. Surg Innov 18:248–253

    Article  PubMed  Google Scholar 

  15. Lehur PA, Stuto A, Fantoli M et al (2008) Outcomes of stapled transanal rectal resection vs. biofeedback for the treatment of outlet obstruction associated with rectal intussusception and rectocele: a multicenter, randomized, controlled trial. Dis Colon Rectum 51:1611–1618

    Article  PubMed  Google Scholar 

  16. Schwandner O, Fürst A (2010) German STARR Registry Study Group. Assessing the safety, effectiveness, and quality of life after the STARR procedure for obstructed defecation: results of the German STARR registry. Langenbecks. Arch Surg 395:505–513

    Article  Google Scholar 

  17. Boccasanta P, Venturi M, Roviaro G (2007) Stapled transanal rectal resection versus stapled anopexy in the cure of hemorrhoids associated with rectal prolapse. A randomized controlled trial. Int J Colorectal Dis 22:245–251

    Article  PubMed  Google Scholar 

  18. Goede AC, Glancy D, Carter H, Mills A, Mabey K, Dixon AR (2011) Medium term results of stapled transanal rectal resection (STARR) for obstructed defecation and symptomatic rectal-anal intussusception. Colorectal Dis 13:1052–1057

    Article  CAS  PubMed  Google Scholar 

  19. Boffi F (2007) Rectal stricture, pocket and fistula after STARR procedure: lay-open, curettage and rectal advancement flap. Tech Coloproctol 11:195

    Article  Google Scholar 

  20. Pescatori M, Dodi G, Salafia C, Zbar AP (2005) Rectovaginal fistula after double-stapled transanal rectotomy (STARR) for obstructed defaecation. Int J Colorectal Dis 20:83–85

    Article  PubMed  Google Scholar 

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Acknowledgments

There is no funding support from private enterprises. The project was supported by the Health Institutions involved.

Conflict of interest

There are no conflicts of interest.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Specialties Hospital “Dr. Antonio Fraga Mouret” National Medical Center “La Raza”, Mexican Institute of Social Security, Mexico City, Mexico

    M. Blas-Franco, M. A. Pichardo Farfan & J. Hernández Figueroa

  2. Department of Colorectal Surgery, General Hospital “Dr. Manuel Gea Gonzalez”, Calzada de Tlalpan 4800, Seccion XVI, Tlalpan, 14050, Mexico City, Mexico

    M. Blas-Franco & J. de Jesus Herrera Esquivel

  3. Department of General Surgery, General Hospital “Dr. Manuel Gea Gonzalez”, Mexico City, Mexico

    C. Valenzuela-Salazar, E. De la Concha-Blankenagel & J. Bahena Aponte

  4. Department of Pathology, Specialties Hospital “Dr. Antonio Fraga Mouret” National Medical Center “La Raza”, Mexican Institute of Social Security, Mexico City, Mexico

    P. Ramírez Mendoza

Authors
  1. M. Blas-Franco
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  2. C. Valenzuela-Salazar
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  3. E. De la Concha-Blankenagel
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  4. M. A. Pichardo Farfan
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  5. P. Ramírez Mendoza
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  6. J. Hernández Figueroa
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  7. J. Bahena Aponte
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  8. J. de Jesus Herrera Esquivel
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Corresponding author

Correspondence to C. Valenzuela-Salazar.

Additional information

This protocol was approved by the institutional review and ethics committee, in both Institutions, and meets the guidelines of their responsible governmental health agency.

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Blas-Franco, M., Valenzuela-Salazar, C., De la Concha-Blankenagel, E. et al. Stapled transanal longitudinal posterior proctectomy (STALPP) in total rectal prolapse: a 7-year experience. Tech Coloproctol 18, 173–178 (2014). https://doi.org/10.1007/s10151-013-1028-5

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  • DOI: https://doi.org/10.1007/s10151-013-1028-5

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