Rectal prolapse is the downward displacement of the anal canal, rectal mucosa, the entire rectum and part of the sigmoid colon, which prolapses outside the anus. There are many treatment methods, and due to the heavy tissue damage caused by extensive dissection in some procedures, there are more postoperative complications and sequelae [[i]]. From August 2005 to September 2009, we performed 31 cases of stapler transanal partial resection of rectum (STAPRE), and achieved good results. Li Dongbing, Department of Anorectal Medicine, Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine 1 Clinical data There were 31 cases in this group, 6 cases with Ⅰ degree prolapse, 16 cases with Ⅱ degree and 9 cases with Ⅲ degree. The length of Ⅲ degree prolapse did not exceed 15 cm. 18 cases were male and 13 cases were female; age ranged from 24 to 73 years, with an average of 56.1±3.3 years. The duration of disease ranged from 12 months to 21 years, with a median of 5.6 years. Sixteen cases were followed up for more than 12 months and 15 cases for more than 6 months after surgery. There were 2 cases with serious comorbidities, 1 case of schizophrenia, and 1 case of renal insufficiency.2 Methods Disposable or replaceable PPH surgical anastomosis produced by Changzhou Haida Surgical Instrument Factory and Suzhou Frankman Surgical Instrument Factory was used. Two enemas with 600-800 ml of soap and water were administered on the day of surgery. Lumbar or epidural anesthesia in lithotomy position. The prolapsed rectum is exposed with a semi-cylindrical dilator and 3-4 figure-of-eight sutures are made at the prolapsed rectum to pull the prolapsed rectum, depending on the situation. The prolapsed rectum is pulled into the staple compartment by tightening the adjusting knob of the anastomosis body and pulling the purse-string. Rotate the knob until it is positioned and then strike, release, and rotate the knob to gently remove the anastomosis. Check the extent of prolapsed rectum resection, and the residual prolapse is resected by the same method again as a figure 8 suture with the anastomosis, see Figure 1 and Figure 2. 3 to 4 times of resection can be repeated in one operation. If there is active bleeding, “8” type suture with 3-0 absorbable thread is used to put in hemostatic dressing and ventilator, and no anal tightening is done. Among the 31 cases in this group, 12 of the 21 cases were resected in 2 surgical sessions using 3 clutches in the same operation; 9 cases were resected in 2 surgical sessions using 4 clutches; 6 cases were resected in only one operation using 4 clutches; and 4 cases were resected in 3 clutches. The interoperative interval was 10 days to 2 weeks for 2 separate surgeries. Postoperative bed rest for 1 day, fasting for 3 days, routine fluid replacement and antibiotics for 3 days. Bowel movements were controlled for 3 days. Author’s unit: Department of Anal Surgery, Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine 1000913 Efficacy criteria for determining rectal prolapse (Chinese Society of Traditional Chinese Medicine, Anal Branch, November 2002): healed as Ⅰ degree prolapse symptoms disappeared, rectal mucosa no longer prolapsed out of the anus; Ⅱ and Ⅲ degree prolapse, the whole rectum no longer prolapsed out of the anus. Improvement was the basic disappearance of symptoms and significant reduction of prolapse. Follow-up visits were made at 0.5, 1, 3, 6 and 12 months after surgery to observe signs of prolapse recurrence. In case of prolapse, a second operation was performed 15-20 days after the first operation.4 Results Among the 31 cases in this group, 21 cases showed prolapse during the first postoperative bowel movement, but the degree was less than 1/3 of the original one, which was cured after the second operation. There was no recurrence after 12 months of follow-up. 10 cases were cured after 6 to 12 months of follow-up. Intraoperative bleeding ranged from 50 to 150 ml, with a median of 76 ml. Operative time ranged from 25 to 50 minutes, with a median of 33 minutes. Hospitalization time ranged from 3 to 21 days, with a median of 8 days. There was no postoperative intestinal stricture, no defecation or bowel control disorder, and no abdominal pain or other complications.4 Discussion The choice of rectal prolapse procedure has been one of the hot spots of debate. None of the previous procedures have been efficaciously stable or very safe [[ii]]. Transabdominal proctocolectomy cannot completely avoid anastomotic leakage and intestinal adhesions and is only suitable for severe rectal prolapse. We believe that it is more appropriate to use this procedure for more than 15 cm. The disadvantage of this procedure is the large surgical trauma and its possible complications. Local excision using the natural lumen is easy, less painful, and has fewer side effects, but the small caliber of the rectal lumen and the curved ducts make the operation inconvenient and difficult. Rectal surgery also has to consider the effect of bleeding on the operative field and the problem of peritonitis caused by intestinal breakage. Total rectal resection does not facilitate hemostasis of the mesenteric vessels, and the large amount of intraoperative bleeding has affected the development of the procedure represented by Delomor. This method makes full use of the exposure of the dilator and can easily expose the operative field up to 7 cm. but beyond 10 cm, the operation will present serious difficulties. As the rectum prolapses and folds, prolapse up to 14 cm can be handled. Previously, in transanal surgery, bleeding had a significant effect on the operative field, leading to recurrence in areas where resection was not easily controlled and the depth of resection was too shallow and too small. the use of the PPH surgical anastomosis has created the conditions to solve this problem [[iii]]. Making multiple figure-of-eight sutures at the base of the rectum to be resected can have a pulling and increasing resection depth effect and more accurately define the surgical area, thus making the intended resection area easily controllable. Due to the pulling effect, the resection can be made deeper or beyond the muscular layer, thus making it suitable for total rectal prolapse [[iv]]. The stable quality and cheap price of domestic anastomotic nail pods create conditions for multiple and multiple use by the operator according to the needs of the condition. Since resection and wound suturing are performed simultaneously, the operation time is short and bleeding is minimal. Therefore, the general condition of the patient, except for the length of prolapse, is no longer an important factor affecting the surgical outcome. In the past, the operation through the sacral approach was very difficult for more than 5 cm and the scope of resection would be limited. The selection of cases should consider: (1) the length of prolapse should not be greater than 10 cm to avoid operational difficulties in accessing the abdominal cavity. (2) If the prolapse is greater than 10 cm, the prolapse can be lowered first with an injection of Hemorrhoidolin and then STAPRE, which ensures safety because the Hemorrhoidolin injection only seeks to lower the prolapse and not to cure it [[v]]. For prolapsed hemorrhoids of 11 to 15 cm, we can reduce the length of prolapsed hemorrhoids by 5 cm by injection, i.e., from third degree to second degree. For prolapse greater than 15 cm, open rectosigmoidectomy can be considered. Based on this consideration, the classification should be changed from third degree to fourth degree, i.e., those larger than 15 cm are classified as fourth degree. The third degree of the original classification is not suitable for guiding treatment. References: [[i]] Li Yingchao, Li Solin, Ren Huaizhen. Laparoscopic-assisted pelvic floor peritoneal band rectal suspension for complete rectal prolapse in children[J]. Chinese Journal of Minimally Invasive Surgery,2009,19(7):582.