Surgical options and trends in treating rectal prolapse: long-term results in a 19-year follow-up study

Abstract

Purpose: Many different operations have been proposed for treating rectal prolapse, with varying recurrence rates and functional outcome. The main purpose of this study was to assess long term results of surgery for prolapse of the rectum. Methods:We carried out a retrospective study to evaluate changing trends in surgical strategies and outcome in patients treated in our hospital over 19 years.Results: Ninety-three patients were operated and 30 (32%) experienced recurrence of external prolapse during a median (range) follow-up time of 82 (2-231) months. There were 37 reoperations for recurrence, bringing the total number of operations to 130.From 1998 to 2010 laparoscopic posterior suture rectopexy was the preferred abdominal procedure with Delorme's operation as the perineal alternative. Observed recurrence rates were 15/49 (31%) and 8/15 (53%) during a median observation time of 84 and 9 months respectively.From 2011 to 2017 these procedures were replaced by ventral mesh rectopexy and Altemeier's rectosigmoidectomy. The observed recurrence rate for ventral mesh rectopexy was 3/22 (14%) during a median observation time of 29 months. The 30-day mortality rate was 3% and complication rate 14%. Conclusions:The recurrence rates were high after all procedures, with no significant difference between posterior suture rectopexy and ventral mesh rectopexy, but the observation time for the latter procedure was too short to conclude. Both procedures had low complication rates, and ventral mesh rectopexy had no mortality.

Functional Outcome after Laparoscopic Posterior Sutured Rectopexy Versus Ventral Mesh Rectopexy for Rectal Prolapse: Six-year Follow-up of a Double-blind, Randomized Single-center Study

“…Regarding recurrences rates, in concordance with the previously published study [7], [19], it was lower in the LVMR group (8.82%) than in the LPSR group (23.33%). This didn't reach statistical significance, but the study was not powered for recurrence and a type II error is quite possible.…”

Mesh-related complications and recurrence after ventral mesh rectopexy with synthetic versus biologic mesh: a systematic review and meta-analysis

“…Publication dates varied from 2004 to 2020. Fifteen studies had a retrospective design [ 10 , 12 , 16 , 19 – 21 , 23 – 25 , 27 , 31 , 32 , 34 , 36 , 39 ], 12 had a prospective design [ 1 , 22 , 26 , 28 – 30 , 35 , 37 , 38 , 40 , 41 , 43 ] and four [ 3 , 42 , 44 , 45 ] were RCT’s. In one study, the design was not specified [ 33 ].…”

“…Fifteen studies reported on mesh-related complications, including four studies [16][17][18][19] that were not considered for further analysis due to failing the quality assessment. The remaining 11 studies included eight studies of low quality [10,12,[20][21][22][23][24][25] and three studies of medium quality [3,26,27] (Table 1).…”

“…Thirty studies reported on recurrence, including one study that was not considered for further analysis after quality assessment [17]. The remaining 29 studies included 13 studies of low quality [10,16,19,20,22,24,[28][29][30][31][32][33][34], 11 studies of medium quality [1,21,26,27,[35][36][37][38][39][40][41], and five studies as high quality [3,[42][43][44][45] (Table 1).…”

Surgical Treatment of Iatrogenic Complex Recurrent Extrasphincter Anorectal Fistula: A Clinical Case

“…В исследовании Gleditsch et al были продемонстрированы 19-летние исходы ректопексии различными методиками (лапароскопические и открытые операции с или без использования сетчатых имплантов). За этот период не было выявлено ни одного случая формирования свища прямой кишки без эрозии сетчатого импланта [5]. При лапароскопической ректопексии с использованием сетчатых имплантов редко встречаются случаи эрозии имплантов в стенки органов (прямая кишка, мочевой пузырь, свод и канал влагалища) с образованием свищевых ходов (1,3-2%), также были описаны случаи образования свищевых ходов (чаще ректовагинальных) без эрозии импланта [6][7][8].…”