Resection Rectopexy is Still an Acceptable Operation for Rectal Prolapse

Abstract

The aim of this study was to compare resection rectopexy (RR) with ventral mesh rectopexy (VMR). This institutional review board–approved retrospective study compared patients with rectal prolapse, who underwent RR or VMR from 2009 to 2016. The primary end point was the comparison of complications and prolapse recurrence rates. Seventy-nine RR and 108 VMR patients qualified. Using propensity score matching, the two groups were not significantly different (P = 0.818). There were no differences regarding gender (female 103 vs 72; P = 0.4) and age (59.3 vs 53.9; P = 0.054). Patients in the VMR group had a greater body mass index (25.5 vs 22.9; P = 0.001) and poorer physical status (American Society of Anesthesiologists 3 57.4% vs 41.8%; P = 0.04). The VMR group had more: robotic approaches (69.4% vs 8.9%; P < 0.001), concomitant urogynecological procedures (63 vs 19; P < 0.001), and longer operative time (269 vs 206 minutes; P < 0.001) but a reduced length of stay (2 vs 5 days; P < 0.001). The median follow-up (16 vs 26 months; P = 0.125) and the median time of recurrence (14 vs 38 months; P = 0.163) were similar. No differences were observed for complications or recurrence (10.2% vs 10.1%; P = 0.43). We failed to identify superiority based on surgical technique.

Mesh Rectopexy or Resection Rectopexy for Rectal Prolapse; Is There a Gold Standard Method: A Systematic Review, Meta-Analysis and Trial Sequential Analysis

“…Two [ 11 , 12 ] out of the eight selected studies had extractable data on the operating time of the procedures carried out, and our statistical analysis showed that the two methods did not differ significantly (WMD 68.16, 95% CI −30.28 to 166.6). This analysis is shown in Figure 2 .…”

“…The remaining articles were not included because they investigated different research questions to the one of our study, or on the grounds of including non-adult patients, or because the required data were not extractable. Following the full-text analysis, eight studies in total [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ] were eligible for inclusion in the qualitative and quantitative analysis. The selection process of the included articles can be found in Figure 1 .…”

“… Forest plot demonstrating the comparison of the overall complication rate [ 12 , 13 , 14 , 15 , 18 , 19 ]. …”

“… Risk of bias summary showing the level of risk of bias for each study included in the meta-analysis [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. …”

“…The rectopexy is completed by suturing the anterior rectal wall to the peritoneum. Mesh rectopexy without resection is another alternative that consists of a mesh or biological graft placement to reinforce either the anterior rectum or to fixate the rectum on the sacrum [ 12 , 13 , 14 , 15 ]. In this procedure, the initial dissection is similar to the one carried out for the resection rectopexy.…”