Surgical Techniques And Curative Effect Analysis Of Perineal Stapled Prolapse Resection In The Treatment Of Rectal Prolapsed

Background:Rectal prolapse(RP)is the disorder characterized by partial or full-thickness prolapse of the rectum.Among them,complete RP is the protrusion of the entire layer of the rectum outside the anus,in which the rectum passes externally beyond the anal sphincters.RP is associated with the concomitant symptoms of defecation disorders and discomfort of anus.RP frequently occurs when patients forcefully defecate.Prolapsed rectum would return to anal sphincter spontaneously or manually when severe.Enema,strangulation or even necrosis may be observed in prolapsed rectum,which severely affects the quality of life,if prolapsed rectum is unable to return to the place promptly.The pathogenesis of RP remains elusive,and sliding hernia theory and internal rectal intussusception are currently two main associated explanations.At present,surgery is the main form of treatment for RP,and mainly contains two general approaches,including abdominal and perineal approaches.In the past abdominal approaches were widely used because of its low postoperative recurrence rate and slight damage in rectal and anal physiological functions.Nevertheless as its operating time is long and the injury is heavy,the incidence of postoperative complications is relatively high in elder patients or patients with systemic diseases.Thus perineal approaches are safer choices compared with abdominal approaches for high-risk patients.Performing perineal approaches is more difficult when patients are elderly or obese,or when prolapsed rectum is too long or severe edema in prolapsed rectum is observed.In that case,therapeutic effect should be ensured meanwhile operating time should be shortened.Therefore how to complete surgery safely and rapidly to minimize surgical wound and postoperative complications are urgent problems to be solved.Objective :The study is aimed to preliminarily evaluate the surgical techniques and therapeutic effect of perineal stapled prolapsed resection(PSP)in the treatment of rectal prolapse.Methods:In this investigation,we reviewed and analyzed the clinical data of twelve recruited subjects who were diagnosed with full-thickness RP and received PSP surgical treatment during June 2012 and January 2017 in our group.The linear section stapler was used at the 3 and 9 o'clock positions of the completely prolapsed rectum,respectively,to separate two folding intestinal walls and the suture line ended 1-2cm from the dentate line,which produced two semicircular flaps in prolapsed rectum.In the case that no damage of intraperitoneal visceral organs is observed via the detection of laparoscopy,anterior and posterior prolapsed intestinal tissue were resected by arc section stapler 2cm parallel to the dentate line,and then the neo-rectum fell back into the place spontaneously.The suture line should be checked to ensure hemostasis and to reinforce it via figure-eight loop with absorbable lines in stoma corner and interrupted suture in stoma mucosa.During postoperative period,the relieving of associated symptoms,the change in Wexner score and the recurrence of related complications were assessed.Results:All patients were successfully operated.The mean operating time was 49.75min(range 35-69min),the mean haemorrhagia amount was 10.58 ml,and the mean postoperative stay was 9.83 d.Postoperative stoma haemorrhage was observed in 2 subjects,in which one subjects were cured by compression hemostasis with anal tamponade and one subject was cure by anal suture hemostasis.No anastomotic leakage and stricture was observed.All patients were fully recovered,and postoperative health education and follow-up were carried out by telephone contact and outpatient referral.All patients received follow-up and the mean follow-up was 20.33 months(range 18-24).During the follow-up period no prolapse and postoperative complications,such as frequent stool,fecal incontinence and bowel obstruction were observed,and the improvement in obstructed defecation syndrome was also found.In addition,no recurrence was observed in all subjects.The mean Wexner score was 14.67 before surgical intervention,and was 4.17 one month after surgery,which showed significant difference(P<0.001).Conclusion:PSP is characterized by minimal damage,simple operation,short operating time,rapid post-operative recovery and exact short-term therapeutic effect,and can effectively ameliorate related symptoms of full-thickness RP patients.Besides PSP is a safe and effective therapy to moderate or severe RP patients who are elderly,poor-condition or get concomitant systemic diseases.