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Kumari M, MadhuBabu M, Vaidya H, Mital K, Pandya B. Outcomes of Laparoscopic Suture Rectopexy Versus Laparoscopic Mesh Rectopexy: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e61631. [PMID: 38966481 PMCID: PMC11223666 DOI: 10.7759/cureus.61631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/06/2024] Open
Abstract
The contemporary literature provides conflicting evidence regarding the precedence of laparoscopic mesh rectopexy over laparoscopic suture rectopexy for full-thickness rectal prolapse. This study aimed to compare the clinical outcomes of mesh and suture rectopexy to improve the surgical management of complete rectal prolapse. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to extract studies based on mesh versus suture rectopexy and published from 2001 to 2023. The articles of interest were obtained from PubMed Central, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Journal Storage (JSTOR), Web of Science, Embase, Scopus, and the Cochrane Library. The primary outcomes included rectal prolapse recurrence, constipation improvement, and operative time. The secondary endpoints included the Cleveland Clinic Constipation Score, Cleveland Clinic Incontinence Score, intraoperative bleeding, hospital stay duration, mortality, overall postoperative complications, and surgical site infection. A statistically significant low recurrence of rectal prolapse (odds ratio: 0.41, 95% confidence interval (CI) 0.21-0.80; p=0.009) and longer mean operative duration (mean difference: 27.05, 95% CI 18.86-35.24; p<0.00001) were observed in patients with mesh rectopexy versus suture rectopexy. Both study groups, however, had no significant differences in constipation improvement and all secondary endpoints (all p>0.05). The laparoscopic mesh rectopexy was associated with a low postoperative rectal prolapse recurrence and a longer operative duration compared to laparoscopic suture rectopexy. Prospective randomized controlled trials should further evaluate mesh and suture rectopexy approaches for postoperative outcomes to inform the surgical management of complete rectal prolapse.
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Affiliation(s)
- Meena Kumari
- Department of General Surgery, All India Institute of Medical Sciences, Bhopal, IND
| | | | - Harsh Vaidya
- Department of Surgery, All India Institute of Medical Sciences, Bhopal, IND
| | - Kushal Mital
- Department of Coloproctology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, IND
| | - Bharati Pandya
- Department of General Surgery, All India Institute of Medical Sciences, Bhopal, IND
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Habeeb TAAM, Podda M, Chiaretti M, Kechagias A, Lledó JB, Kalmoush AE, Mustafa FM, Nassar MS, Labib MF, Teama SRA, Elshafey MH, Elbelkasi H, Alsaad MIA, Sallam AM, Ashour H, Mansour MI, Mostafa A, Elshahidy TM, Yehia AM, Rushdy T, Ramadan A, Hamed AEM, Yassin MA, Metwalli AEM. 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. Tech Coloproctol 2024; 28:48. [PMID: 38619626 PMCID: PMC11018677 DOI: 10.1007/s10151-024-02919-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/16/2024] [Indexed: 04/16/2024]
Abstract
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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Affiliation(s)
- T A A M Habeeb
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt.
| | - M Podda
- Department of Surgical Science, Cagliari University Hospital, Monserrato, 09042, Cagliari, Italy
| | - M Chiaretti
- Paride Stefanini General and Specialist Surgery Department, Sapienza University of Rome IT, Rome, Italy
| | - A Kechagias
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere, Finland
| | - J B Lledó
- Department of Surgery, La Fe University Hospital, Valencia, Spain
| | | | - Fawzy M Mustafa
- General Surgery Department, Faculty of Medicine, Al-Azher University, Cairo, Egypt
| | | | - Mohamed Fathy Labib
- General Surgery Department, Faculty of Medicine, Al-Azher University, Cairo, Egypt
| | | | | | - Hamdi Elbelkasi
- General Surgery Department, Mataryia Teaching Hospital (GOTHI), Cairo, Egypt
| | | | - Ahmed M Sallam
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Hassan Ashour
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Mohamed Ibrahim Mansour
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Abdelshafy Mostafa
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Tamer Mohamed Elshahidy
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Ahmed M Yehia
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Tamer Rushdy
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Alaaedin Ramadan
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Abd Elwahab M Hamed
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Mahmoud Abdou Yassin
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Abd-Elrahman M Metwalli
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
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Schabl L, Hull T, Erozkan K, Alipouriani A, Ban KA, Steele SR, Spivak AR. Ventral mesh rectopexy for recurrent rectal prolapse after Altemeier perineal proctosigmoidectomy: feasibility and outcomes. Langenbecks Arch Surg 2024; 409:49. [PMID: 38305915 PMCID: PMC10837248 DOI: 10.1007/s00423-024-03227-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/03/2024] [Indexed: 02/03/2024]
Abstract
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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Affiliation(s)
- Lukas Schabl
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Tracy Hull
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Kamil Erozkan
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Ali Alipouriani
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Kristen A Ban
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Scott R Steele
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Anna R Spivak
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA.
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