Abstracts - Chirurgie Kongress

ection of the rectal prolapse, meanwhile laparoscopic colposacropexy (LCS) with obliteration of the
Douglas pouch avoids further descend of the perineal region. The aim of this study is to access the
feasibility and the functional outcome of the combination of these two procedures.
Methods: Between March 2007 and August 08 Patients with symptomatic POP were selected to receive
the STARR procedure in combination with the LSC. The STARR procedure was performed with
the Contour ® TranstarTM device. A lightweight partially absorbable mesh (Ultrapro ® ) was used for the
LSC. Functional outcome was measured by Symptom Severity Score (SSS), obstructed defecation syndrome
(ODS) Score and Wexner Score before, six weeks and three months after surgical intervention.
Results: 12 consecutive female patients, median age 61 years (range 34 – 78), were enrolled in the
study. A part of one patient suffered postoperative iatrogenic perforation of sigmoid colon, no other
complications and no mortality occurred. SSS, ODS and Wexner score improved significantly over the
follow-up: before, six weeks and three months after the intervention median SSSs were 11 (6-20), 5
(0-16, p>0.031), 3 (0-10, p>0.031), the ODS scores 18 (6-20); 4 (1–16, p>0.016); 4 (2-14, p>0.031),
and the Wexner scores 0 (0-6), 0 (0-7), 0 (0-9, p>0.375), respectively.
Conclusion: The combination of these two minimal invasive procedures is feasible and safe. It is an
effective treatment for complex pelvic floor disorders with good functional outcome.
13.5
Functional outcome after Perineal Stapled Prolaps Resection (PSP)
F. Hetzer, A. Roushan, L. Marti, K. Wollf, J. Lange (St.Gallen)
Objective: A new surgical technique, the Perineal Stapled Prolapse resection (PSP), for external rectal
prolapse was introduced by a feasibility study in 2008. This study now presents the first results of a
larger patients` number with functional outcome in a midterm follow-up.
Methods: From July 2007 to December 2008 the PSP was performed on 28 patients with external
rectal prolapse by the same surgeon. The prolapse was completely pulled out and then axially cut
open at three o’clock in lithotomy position with a straight stapler. Finally the prolapse was stepwise
resected with the curved Contour ® TranstarTM stapler at prolapses’ uptake. Perioperative morbidity
and functional outcome was prospectively documented by different scores.
Results: In all 28 patients, median age 82 years (range 26-93), PSP was performed with no intraoperative
complications. One third of the included patients complained a recurrent prolapse. 14% postoperative
complications occurred, two patients had a first degree complication (= no specific treatment
necessary), one patient a second degree (= need special medication) and one a third degree (= interventional
treatment necessary). No mortality. The median operation time was 31 minutes (15-60), the
median hospital stay 6 days (2-29). Functional result of 25 of 28 (89%) of the patients were available
after a median time of 9 months (1-17) The median reduction of the Wexner score was from 17 (8-20)
before surgery to 0.5 (0-14) postoperatively, P 0.05). In IFX the operation rate was 0.5 and 1.0 before and after
initiation of infliximab therapy per 10 years observation time, respectively (p>0.05). Crohn’s disease
activity index was 183.5 (100-165) before and 128.5 (147-223) under infliximab therapy at enrolment
(n=31, p