Top

Published in:

Open Access 01-12-2024 | Rectal Prolapse | Original Article

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

Authors: T. A. A. M. Habeeb, M. Podda, M. Chiaretti, A. Kechagias, J. B. Lledó, Abd-Elfattah Kalmoush, Fawzy M. Mustafa, Mohammed Shaaban Nassar, Mohamed fathy Labib, Sobhy rezk ahmed Teama, Mohammed Hassan Elshafey, Hamdi Elbelkasi, Mohamed Ibrahim Abo Alsaad, Ahmed M. Sallam, Hassan Ashour, Mohamed Ibrahim Mansour, Abdelshafy Mostafa, Tamer Mohamed Elshahidy, Ahmed m. Yehia, Tamer Rushdy, Alaaedin Ramadan, Abd Elwahab M. Hamed, Mahmoud Abdou Yassin, Abd-Elrahman M. Metwalli

Published in: Techniques in Coloproctology | Issue 1/2024

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.

Bordeianou L, Paquette I, Johnson E et al (2017) Clinical practice guidelines for the treatment of rectal prolapse. Dis Colon Rectum 60(11):1121–1131. https://doi.org/10.1097/DCR.0000000000000889CrossRefPubMed

Yiasemidou M, Yates C, Cooper E, Goldacre R, Lindsey I (2023) External rectal prolapse: more than meets the eye. Tech Coloproctol 27(10):783–785. https://doi.org/10.1007/s10151-023-02829-8CrossRefPubMed

Gallo G, Martellucci J, Pellino G et al (2018) Consensus statement of the Italian Society of Colorectal Surgery (SICCR): management and treatment of complete rectal prolapse. Tech Coloproctol 22(12):919–931. https://doi.org/10.1007/s10151-018-1908-9CrossRefPubMed

Emile SH, Elfeki H, Shalaby M, Sakr A, Sileri P, Wexner SD (2019) Outcome of laparoscopic ventral mesh rectopexy for full-thickness external rectal prolapse: a systematic review, meta-analysis, and meta-regression analysis of the predictors for recurrence. Surg Endosc 33(8):2444–2455. https://doi.org/10.1007/s00464-019-06803-0CrossRefPubMed

Emile SH, Khan SM, Garoufalia Z et al (2023) A network meta-analysis of surgical treatments of complete rectal prolapse. Tech Coloproctol 27(10):787–797. https://doi.org/10.1007/s10151-023-02813-2CrossRefPubMed

Scherer R, Marti L, Hetzer FH (2008) Perineal stapled prolapse resection: a new procedure for external rectal prolapse. Dis Colon Rectum 51(11):1727–1730. https://doi.org/10.1007/s10350-008-9423-0CrossRefPubMed

Romano G, Bianco F, Caggiano L (2009) Modified perineal stapled rectal resection with contour transtar for full-thickness rectal prolapse. Colorectal Dis 11(8):878–881. https://doi.org/10.1111/j.1463-1318.2009.01901.xCrossRefPubMed

Kössler-Ebs JB, Grummich K, Jensen K et al (2016) Incisional hernia rates after laparoscopic or open abdominal surgery—a systematic review and meta-analysis. World J Surg 40(10):2319–2330. https://doi.org/10.1007/s00268-016-3520-3CrossRefPubMed

Brown SR, Pearson K, Hainsworth A, Williams A (2022) Treatment of recurrent rectal prolapse after a laparoscopic ventral mesh rectopexy. Tech Coloproctol 26(12):991–995. https://doi.org/10.1007/s10151-022-02689-8CrossRefPubMed

10.

Mäkelä-Kaikkonen J, Rautio T, Ohinmaa A et al (2019) Cost-analysis and quality of life after laparoscopic and robotic ventral mesh rectopexy for posterior compartment prolapse: a randomized trial. Tech Coloproctol 23(5):461–470. https://doi.org/10.1007/s10151-019-01991-2CrossRefPubMedPubMedCentral

11.

Vandenbroucke JP, Elm EV, Altman DG et al (2007) Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Ann Intern Med 147(8):W-163–W-194. https://doi.org/10.7326/0003-4819-147-8-200710160-00010-w1CrossRef

12.

Park B-S, Cho SH, Son GM et al (2021) Absent or impaired rectoanal inhibitory reflex as a diagnostic factor for high-grade (grade III–V) rectal prolapse: a retrospective study. BMC Gastroenterol 21(1):157. https://doi.org/10.1186/s12876-021-01729-1CrossRefPubMedPubMedCentral

13.

WHO. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Accessed 1 Oct 2022

14.

Seong MK, Jung SI, Kim TW, Joh HK (2011) Comparative analysis of summary scoring systems in measuring fecal incontinence. J Korean Surg Soc 81(5):326–331. https://doi.org/10.4174/jkss.2011.81.5.326CrossRefPubMedPubMedCentral

15.

Altomare D, Spazzafumo L, Rinaldi M, Dodi G, Ghiselli R, Piloni V (2008) Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome. Colorectal Dis 10(1):84–88. https://doi.org/10.1111/j.1463-1318.2007.01262.xCrossRefPubMed

16.

Clavien PA, Barkun J, De Oliveira ML et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2CrossRefPubMed

17.

Tutticci N, Klein A, Sonson R, Bourke MJ (2016) Endoscopic resection of subtotal or completely circumferential laterally spreading colonic adenomas: technique, caveats, and outcomes. Endoscopy. https://doi.org/10.1055/s-0042-101854CrossRefPubMed

18.

Solari S, Martellucci J, Ascanelli S et al (2022) Predictive factors for functional failure of ventral mesh rectopexy in the treatment of rectal prolapse and obstructed defecation. Tech Coloproctol 26(12):973–979. https://doi.org/10.1007/s10151-022-02708-8CrossRefPubMedPubMedCentral

19.

van der Schans EM, Paulides TJC, Wijffels NA, Consten ECJ (2018) Management of patients with rectal prolapse: the 2017 Dutch guidelines. Tech Coloproctol 22(8):589–596. https://doi.org/10.1007/s10151-018-1830-1CrossRefPubMed

20.

Ramage L, Simillis C, Yen C et al (2017) Magnetic resonance defecography versus clinical examination and fluoroscopy: a systematic review and meta-analysis. Tech Coloproctol 21:915–927. https://doi.org/10.1007/s10151-017-1704-yCrossRefPubMed

21.

Piloni V, Bergamasco M, Melara G, Garavello P (2018) The clinical value of magnetic resonance defecography in males with obstructed defecation syndrome. Tech Coloproctol 22:179–190. https://doi.org/10.1007/s10151-018-1759-4CrossRefPubMed

22.

Martin-Martin GP, Garcia-Armengol J, Roig-Vila JV et al (2017) Magnetic resonance defecography versus videodefecography in the study of obstructed defecation syndrome: is videodefecography still the test of choice after 50 years? Tech Coloproctol 21:795–802. https://doi.org/10.1007/s10151-017-1666-0CrossRefPubMed

23.

Khalil OH, Habeeb TA, Sieda BM (2020) Modified perineal linear stapler resection for external rectal prolapse. Ann Med Surg 54:22–25. https://doi.org/10.1016/j.amsu.2020.03.011CrossRef

24.

Farag A, Mashhour AN, Raslan M, Tamer M, Elbarmelgi MY (2020) Laparoscopic pelvic organ prolapse suspension (Pops) versus laparoscopic ventral mesh rectopexy for treatment of rectal prolapse: prospective cohort study. World J Surg 44:3158–3166. https://doi.org/10.1007/s00268-020-05585-0CrossRefPubMed

25.

Cullen J, Rosselli JM, Gurland BH (2012) Ventral rectopexy for rectal prolapse and obstructed defecation. Clin Colon Rectal Surg 25(01):034–036. https://doi.org/10.1055/s-0032-1301757CrossRef

26.

Faucheron JL, Trilling B, Girard E, Sage PY, Barbois S, Reche F (2015) Anterior rectopexy for full-thickness rectal prolapse: technical and functional results. World J Gastroenterol 21(16):5049. https://doi.org/10.3748/wjg.v21.i16.5049CrossRefPubMedPubMedCentral

27.

McLean R, Kipling M, Musgrave E, Mercer-Jones M (2018) Short-and long-term clinical and patient-reported outcomes following laparoscopic ventral mesh rectopexy using biological mesh for pelvic organ prolapse: a prospective cohort study of 224 consecutive patients. Colorectal Dis 20(5):424–436. https://doi.org/10.1111/codi.13996CrossRefPubMed

28.

Albayati S, Chen P, Morgan MJ, Toh JWT (2019) Robotic vs laparoscopic ventral mesh rectopexy for external rectal prolapse and rectal intussusception: a systematic review. Tech Coloproctol 23(6):529–535. https://doi.org/10.1007/s10151-019-02014-wCrossRefPubMed

29.

Gleditsch D, Wexels WA, Nesbakken A (2018) Surgical options and trends in treating rectal prolapse: long-term results in a 19-year follow-up study. Langenb Arch Surg 403:991–998. https://doi.org/10.1007/s00423-018-1728-4CrossRef

30.

Gouvas N, Georgiou PA, Agalianos C et al (2015) Ventral colporectopexy for overt rectal prolapse and obstructed defaecation syndrome: a systematic review. Colorectal Dis 17(2):O34–O46. https://doi.org/10.1111/codi.12751CrossRefPubMed

31.

Fu CW, Stevenson AR (2017) Risk factors for recurrence after laparoscopic ventral rectopexy. Dis Colon Rectum 60(2):178–186. https://doi.org/10.1097/DCR.0000000000000710CrossRefPubMed

32.

Glasgow SC, Birnbaum EH, Kodner IJ, Fleshman JW, Dietz DW (2008) Recurrence and quality of life following perineal proctectomy for rectal prolapse. J Gastrointest Surg 12:1446–1451. https://doi.org/10.1007/s11605-008-0531-xCrossRefPubMed

33.

Phillips RKS (2002) Colorectal surgery—a companion to specialist surgical practice, 2nd edn. Tech Coloproctol 6(1):65–65. https://doi.org/10.1007/s101510200013CrossRef

34.

Hu B, Zou Q, Xian Z et al (2022) External rectal prolapse: abdominal or perineal repair for men? A retrospective cohort study. Gastroenterol Rep 10:goac007. https://doi.org/10.1093/gastro/goac007CrossRef

35.

Joubert K, Laryea JA (2017) Abdominal approaches to rectal prolapse. Clin Colon Rectal Surg 30(01):057–062. https://doi.org/10.1055/s-0036-1593426CrossRef

36.

Wallenhorst T, Bouguen G, Brochard C et al (2015) Long-term impact of full-thickness rectal prolapse treatment on fecal incontinence. Surgery 158(1):104–111. https://doi.org/10.1016/j.surg.2015.03.005CrossRefPubMed

37.

Emile SH, Youssef M, Thabet W et al (2020) Role of endoanal ultrasonography in grading anal sphincter integrity in rectal prolapse and in predicting improvement in the continence state after surgical treatment. Surg Laparosc Endosc Percutan Tech 30(1):62–68. https://doi.org/10.1097/SLE.0000000000000752CrossRefPubMed

38.

Boons P, Collinson R, Cunningham C, Lindsey I (2010) Laparoscopic ventral rectopexy for external rectal prolapse improves constipation and avoids de novo constipation. Colorectal Dis 12(6):526–532. https://doi.org/10.1111/j.1463-1318.2009.01859.xCrossRefPubMed

39.

Consten EC, van Iersel JJ, Verheijen PM, Broeders IA, Wolthuis AM, D’Hoore A (2015) Long-term outcome after laparoscopic ventral mesh rectopexy. Ann Surg 262(5):742–748. https://doi.org/10.1097/SLA.0000000000001401CrossRefPubMed

40.

Kwak HD, Chung JS, Ju JK (2023) A comparative study between transanal and transabdominal approaches in treatment of complete rectal prolapse. Int J Colorectal Dis 38(1):78. https://doi.org/10.1007/s00384-023-04371-3CrossRefPubMed

41.

Mäkelä-Kaikkonen J, Rautio T, Kairaluoma M et al (2018) Does ventral rectopexy improve pelvic floor function in the long term? Dis Colon Rectum 61(2):230–238. https://doi.org/10.1097/DCR.0000000000000974CrossRefPubMed

42.

Tsunoda A, Takahashi T, Matsuda S, Kusanagi H (2021) Predictive factors for recurrence of external rectal prolapse after laparoscopic ventral rectopexy. J Anus Rectum Colon 5(4):376–385. https://doi.org/10.23922/jarc.2021-024CrossRefPubMedPubMedCentral

43.

Lee JT, Vogler SA, Madoff RD (2019) Chapter 148—diagnosis and management of fecal incontinence. In: Yeo CJ (ed) Shackelford’s surgery of the alimentary tract, 2 volume set (eighth edition). Elsevier, Philadelphia, pp 1721–1732CrossRef

44.

Jayne DG, Schwandner O, Stuto A (2009) Stapled transanal rectal resection for obstructed defecation syndrome: one-year results of the European STARR Registry. Dis Colon Rectum 52(7):1205–1212. https://doi.org/10.1007/DCR.0b013e3181a9120fCrossRefPubMed

45.

Ganapathi SK, Subbiah R, Rudramurthy S, Kakkilaya H, Ramakrishnan P, Chinnusamy P (2022) Laparoscopic posterior rectopexy for complete rectal prolapse: is it the ideal procedure for males? J Minim Access Surg 18(2):295. https://doi.org/10.4103/jmas.JMAS_323_20CrossRefPubMed

46.

Laubert T, Bader FG, Kleemann M, Esnaashari H, Bouchard R, HildebrandRoblick PUJ (2012) Outcome analysis of elderly patients undergoing laparoscopic resection rectopexy for rectal prolapse. Int J Colorectal Dis 27:789–795. https://doi.org/10.1007/s00384-011-1395-1CrossRefPubMed

Title: 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
Authors: T. A. A. M. Habeeb
M. Podda
M. Chiaretti
A. Kechagias
J. B. Lledó
Abd-Elfattah Kalmoush
Fawzy M. Mustafa
Mohammed Shaaban Nassar
Mohamed fathy Labib
Sobhy rezk ahmed Teama
Mohammed Hassan Elshafey
Hamdi Elbelkasi
Mohamed Ibrahim Abo Alsaad
Ahmed M. Sallam
Hassan Ashour
Mohamed Ibrahim Mansour
Abdelshafy Mostafa
Tamer Mohamed Elshahidy
Ahmed m. Yehia
Tamer Rushdy
Alaaedin Ramadan
Abd Elwahab M. Hamed
Mahmoud Abdou Yassin
Abd-Elrahman M. Metwalli
Publication date: 01-12-2024
Publisher: Springer International Publishing
Keywords: Rectal Prolapse
Rectopexy
Fecal Incontinence
Published in: Techniques in Coloproctology / Issue 1/2024
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-024-02919-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2024

Is percutaneous tibial nerve stimulation (PTNS) effective for fecal incontinence (FI) in adults compared with sham electrical stimulation? A meta-analysis

Side-to-side isoperistaltic strictureplasty (Michelassi technique) in extensive Crohn’s disease: a step-by-step video demonstration

Anal trauma caused by bull-horn injury

Robotic-assisted reoperative ileal pouch–anal anastomosis: robotic pouch excision and pouch revision

The implementation of an inflammatory bowel disease-specific enhanced recovery after surgery protocol: an observational cohort study

Treatment techniques for rectovaginal fistulas after low rectal resection for deep endometriosis