Perineal stapled prolapse resection for complete external rectal prolapse: preliminary experience and literature review.

PURPOSE: Perineal stapled prolapse resection (PSP) for external rectal prolapse is a new surgical technique. METHODS: Between April 2009 and January 2011, 5 female patients (mean age, 67 years; range, 53-76) underwent PSP for full-thickness external rectal prolapse. Patients were placed in a slight Trendelenburg position to free the pouch of Douglas from any deep enterocele. Laparoscopic control of the PSP procedure was performed to avoid injury to the bowel in one patient with anorexia. The prolapse was completely resected continuously counterclockwise using a curved Contour® Transtar™ stapler placed parallel to the dentate line. After completion of resection, the neorectum fell back into place spontaneously. RESULTS: Mean operating time was 56 min (range, 40-90). No intraoperative or postoperative complications occurred. No recurrence appeared. The mean hospital stay was 4 days (range, 3-6); the mean follow-up was 6.5 months (range, 2-15). The mean Wexner fecal incontinence score was 9.2 before and 4.6 at 3 months after surgery (p = 0.010); the mean obstructed defecation syndrome score decreased from 16 to 4.75 (p < 0.001). CONCLUSIONS: PSP is an easy, fast and safe procedure. Early functional results are good. Long-term results and recurrence rates need to be investigated further.

Efficacy of Mesoglycan in Pain Control after Excisional Hemorrhoidectomy: A Pilot Comparative Prospective Multicenter Study.

INTRODUCTION: Various pain management strategies for patients undergoing open excisional hemorrhoidectomy have been proposed, yet postoperative pain remains a frequent complaint. OBJECTIVE: To determine whether mesoglycan (30 mg two vials i.m. once/day for the first 5 days postoperative, followed by 50 mg 1 oral tablet twice/day for 30 days) would reduce the edema of the mucocutaneous bridges and thus improve postoperative pain symptoms. PATIENTS AND METHODS: For this prospective observational multicenter study, 101 patients undergoing excisional diathermy hemorrhoidectomy for III-IV degree hemorrhoidal disease were enrolled at 5 colorectal referral centers. Patients were assigned to receive either mesoglycan (study group SG) or a recommended oral dose of ketorolac tromethamine of 10 mg every 4-6 hours, not exceeding 40 mg per day and not exceeding 5 postoperative days according to the indications for short-term management of moderate/severe acute postoperative pain, plus stool softeners (control group CG). RESULTS: Postoperative thrombosis (SG 1/48 versus CG 5/45) (p < 0.001) and pain after rectal examination (p < 0.001) were significantly reduced at 7-10 days after surgery in the mesoglycan-treated group, permitting a faster return to work (p < 0.001); however, in the same group, the incidence of postoperative bleeding, considered relevant when needing a readmission or an unexpected outpatient visit, was higher, possibly owing to the drug's antithrombotic properties. CONCLUSIONS: The administration of mesoglycan after an open diathermy excisional hemorrhoidectomy can reduce postoperative thrombosis and pain at 7-10 days after surgery, permitting a faster return to normal activities.