A network meta-analysis of surgical treatments of complete rectal prolapse

Emile, Sameh Hany; Khan, Sualeh Muslim; Garoufalia, Zoe; Silva‐Alvarenga, Emanuela; Gefen, Rachel; Horesh, Nir; Freund, Michael R.; Wexner, Steven D.

doi:10.1007/s10151-023-02813-2

Cited by 5 publications

(12 citation statements)

References 29 publications

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“…However, an optimal surgical approach has yet to be established [ 1 , 4 ]. Typically, perineal procedures are performed in patients with limited surgical tolerance under spinal anesthesia but are associated with higher recurrence and postoperative fecal incontinence (FI) rates [ 5 ]. Delorme and Altemeier are two commonly performed perineal techniques.…”

Section: Introductionmentioning

confidence: 99%

Comparative study of laparoscopic ventral mesh rectopexy versus perineal stapler resection for external full-thickness rectal prolapse in elderly patients: enhanced outcomes and reduced recurrence rates—a retrospective cohort study

Habeeb,

Podda,

Chiaretti

et al. 2024

Tech Coloproctol

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Background In elderly patients with external full-thickness rectal prolapse (EFTRP), the exact differences in postoperative recurrence and functional outcomes between laparoscopic ventral mesh rectopexy (LVMR) and perineal stapler resection (PSR) have not yet been investigated. Methods We conducted a retrospective multicenter study on 330 elderly patients divided into LVMR group (n = 250) and PSR (n = 80) from April 2012 to April 2019. Patients were evaluated before and after surgery by Wexner incontinence scale, Altomare constipation scale, and patient satisfaction questionnaire. The primary outcomes were incidence and risk factors for EFTRP recurrence. Secondary outcomes were postoperative incontinence, constipation, and patient satisfaction. Results LVMR was associated with fewer postoperative complications (p < 0.001), lower prolapse recurrence (p < 0.001), lower Wexner incontinence score (p = 0.03), and lower Altomare’s score (p = 0.047). Furthermore, LVMR demonstrated a significantly higher surgery–recurrence interval (p < 0.001), incontinence improvement (p = 0.019), and patient satisfaction (p < 0.001) than PSR. Three and 13 patients developed new symptoms in LVMR and PSR, respectively. The predictors for prolapse recurrence were LVMR (associated with 93% risk reduction of recurrence, OR 0.067, 95% CI 0.03–0.347, p = 0.001), symptom duration (prolonged duration was associated with an increased risk of recurrence, OR 1.131, 95% CI 1.036–1.236, p = 0.006), and length of prolapse (increased length was associated with a high recurrence risk (OR = 1.407, 95% CI = 1.197–1.655, p < 0.001). Conclusions LVMR is safe for EFTRP treatment in elderly patients with low recurrence, and improved postoperative functional outcomes. Trial registration Clinical Trial.gov (NCT05915936), retrospectively registered on June 14, 2023.

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Section: Introductionmentioning

confidence: 99%

Comparative study of laparoscopic ventral mesh rectopexy versus perineal stapler resection for external full-thickness rectal prolapse in elderly patients: enhanced outcomes and reduced recurrence rates—a retrospective cohort study

Habeeb,

Podda,

Chiaretti

et al. 2024

Tech Coloproctol

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“…Rectal prolapse is the protrusion of one or all layers of the rectum through the anus [ 1 ]. The treatment for rectal prolapse is surgical and can be performed via perineal and abdominal approaches.…”

Section: Introductionmentioning

confidence: 99%

“…Abdominal approaches include suture rectopexy, ventral mesh rectopexy, and resection rectopexy [ 2 ]. Abdominal approaches are favored as initial procedures in healthy and younger patients [ 1 , 2 ]. The American Society of Colon and Rectum Surgeons (ASCRS) recommend perineal techniques in frail patients, such as Delorme and Altemeier procedure.…”

Section: Introductionmentioning

confidence: 99%

“…This is argued with a decreased surgery time, repeatability, and the possibility of performing without general anesthesia and pneumoperitoneum [ 2 ]. The ASCRS guidelines reflect the current practice and understanding of abdominal and perineal approaches, even though studies from the last two decades have reported conflicting results comparing perineal and abdominal techniques [ 1 ]. The primary Altemeier procedure presents a recurrence rate of 0–58% with varying follow-up periods [ 1 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…The ASCRS guidelines reflect the current practice and understanding of abdominal and perineal approaches, even though studies from the last two decades have reported conflicting results comparing perineal and abdominal techniques [ 1 ]. The primary Altemeier procedure presents a recurrence rate of 0–58% with varying follow-up periods [ 1 , 3 ]. The recurrence rate necessitates surgical options for redo procedures.…”

Section: Introductionmentioning

confidence: 99%

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Ventral mesh rectopexy for recurrent rectal prolapse after Altemeier perineal proctosigmoidectomy: feasibility and outcomes

Schabl,

Hull,

Erozkan

et al. 2024

Langenbecks Arch Surg

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Purpose Recurrence of rectal prolapse following the Altemeier procedure is reported with rates up to 40%. The optimal surgical management of recurrences has limited data available. Ventral mesh rectopexy (VMR) is a favored procedure for primary rectal prolapse, but its role in managing recurrences after Altemeier is unclear. VMR for recurrent prolapse involves implanting the mesh on the colon, which has a thinner wall, more active peristalsis, no mesorectum, less peritoneum available for covering the mesh, and potential diverticula. These factors can affect mesh-related complications such as erosion, migration, or infection. This study assessed the feasibility and perioperative outcomes of VMR for recurrent rectal prolapse after the Altemeier procedure. Methods We queried our prospectively maintained database between 01/01/2008 and 06/30/2022 for patients who had experienced a recurrence of full-thickness rectal prolapse following Altemeier’s perineal proctosigmoidectomy and subsequently underwent ventral mesh rectopexy. Results Ten women with a median age of 67 years (range 61) and a median BMI of 27.8 kg/m2 (range 9) were included. Five (50%) had only one Altemeier, and five (50%) had multiple rectal prolapse surgeries, including Altemeier before VMR. No mesh-related complications occurred during a 65-month (range 165) median follow-up period. Three patients (30%) experienced minor postoperative complications unrelated to the mesh. Long-term complications were chronic abdominal pain and incisional hernia in one patient, respectively. One out of five (20%) patients with only one previous prolapse repair had a recurrence, while all patients (100%) with multiple prior repairs recurred. Conclusion Mesh implantation on the colon is possible without adverse reactions. However, high recurrence rates in patients with multiple previous surgeries raise doubts about using VMR for secondary or tertiary recurrences.

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Systematic literature review and meta-analysis of surgical treatment of complete rectal prolapse in male patients

Emile,

Wignakumar,

Horesh

et al. 2024

Tech Coloproctol

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A network meta-analysis of surgical treatments of complete rectal prolapse

Cited by 5 publications

References 29 publications

Comparative study of laparoscopic ventral mesh rectopexy versus perineal stapler resection for external full-thickness rectal prolapse in elderly patients: enhanced outcomes and reduced recurrence rates—a retrospective cohort study

Comparative study of laparoscopic ventral mesh rectopexy versus perineal stapler resection for external full-thickness rectal prolapse in elderly patients: enhanced outcomes and reduced recurrence rates—a retrospective cohort study

Ventral mesh rectopexy for recurrent rectal prolapse after Altemeier perineal proctosigmoidectomy: feasibility and outcomes

Systematic literature review and meta-analysis of surgical treatment of complete rectal prolapse in male patients

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