Impact of prolapse mass on Contour Transtar technique for third-degree rectal prolapse.

PURPOSE: Contour Transtar procedure for rectal prolapse is a promising technique according to safety and efficacy. One potential surgical problem is failure of the stapler due to the thick rectal wall. In order to evaluate the practicability and the impending limitations of the Contour Transtar technique, we reviewed our data with special respect to the necessity of additional anastomosis suturing.
METHODS: A prospective analysis of 25 consecutive patients, which underwent Contour Transtar procedure from January 2009 to July 2012, was performed. For statistic analysis, the groups with and without additional suturing of the anastomosis were evaluated according to patient characteristics and surgical outcome.
RESULTS: Twenty-five patients, three men and 22 women, underwent transanal Contour Transtar stapling procedure for rectal prolapse. Due to stapling failure, additional suturing of the anastomosis was necessary in 4 of 25 procedures (16%). Age (74.1 vs. 83.1 years) and body mass index (30.8 vs. 22.7 kg/m(2)) were significantly different with and without additional suturing. Operative time was longer (62 vs. 31 min), more cartridges were used (12 vs. 6), and the specimen weight was higher (220 vs. 107 g) in patients with additional suturing. Early postoperative complications were observed in two patients without anastomosis suturing including one patient with bleeding and systemic inflammatory reaction in one case. Postoperative stay did not differ between both groups.
CONCLUSION: Patients with extensive obesity, which present with a substantial rectal prolapse, may need additional suturing of the rectal anastomosis after Contour Transtar stapling. This causes prolonged operative time. However, this does not correlate with complications and it is not related to significant longer hospital stay.