Focused analysis of the surgical management for recurrence of internal rectal prolapse and obstructed defecation syndrome after stapled rectal resection procedures: a long-term single-center experience

BACKGROUND: Stapled rectal resection procedures have been adopted for the treatment of internal rectal prolapse (IRP) and obstructed defecation syndrome (ODS). However, concerns remain in case of surgery for recurrence. This study aimed to analyze the impact of a staple-line scar in patients undergoing surgery for IRP and ODS recurrence. METHODS: A prospective maintained database of patients who underwent abdominal or perineal surgery for IRP and ODS between November 1998 and January 2025 was retrospectively analyzed. Patients with a history of stapled rectal resection procedures were specifically evaluated. Baseline clinical and radiological characteristics, surgical complexity related to stapled suture, postoperative complications, recurrence, and ODS and fecal incontinence scores were collected. RESULTS: Of 376 female patients, 50 (13.3%) with prior stapled rectal resection procedures underwent surgery for IRP and ODS recurrence. In three cases, the staple-line scar could not be safely overcome. At last follow-up, recurrence and complication rates were comparable between patients with and without previous stapled procedures (4.8% vs. 6.1% and 19.0% vs. 18.4%, respectively). One patient in the stapled group experienced persistent pelvic pain despite anatomical correction. Although ODS and fecal incontinence scores improved overall, patients with prior stapled rectal resection reported higher ODS scores. However, linear mixed-effects analysis did not demonstrate statistically significant differences between groups. CONCLUSIONS: Surgery for IRP and ODS recurrence after stapled rectal resection procedures is challenging. Although previous stapled rectal resection procedures may be associated with higher ODS scores, further studies are needed to clarify these findings.