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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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Koimtzis G, Stefanopoulos L, Geropoulos G, Chalklin CG, Karniadakis I, Alawad AA, Alexandrou V, Tteralli N, Carrington-Windo E, Papacharalampous A, Psarras K. Mesh Rectopexy or Resection Rectopexy for Rectal Prolapse; Is There a Gold Standard Method: A Systematic Review, Meta-Analysis and Trial Sequential Analysis. J Clin Med 2024; 13:1363. [PMID: 38592257 PMCID: PMC10933911 DOI: 10.3390/jcm13051363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/25/2024] [Accepted: 02/10/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: Rectal prolapse is a benign condition that mainly affects females and the elderly. The most common symptoms are constipation and incontinence. The treatment of choice is surgical, but so far, there has been no gold standard method. The aim of this study is to compare the two most common intrabdominal procedures utilized for treating rectal prolapse: the resection rectopexy and the mesh rectopexy. (2) Methods: In this study, we conducted a thorough systematic review and meta-analysis of the available literature and compared the two different approaches regarding their complication rate, recurrence rate, and improvement of symptoms rate. (3) Results: No statistically significant difference between the two methods was found regarding the operating time, the length of stay, the overall complication rate, the surgical site infection rate, the cardiopulmonary complication rate, the improvement in constipation and incontinence rates, and the recurrence rate. (4) Conclusions: Our study revealed that mesh rectopexy and resection rectopexy for rectal prolapse have similar short- and long-term outcomes. As a result, the decision for the procedure used should be individualized and based on the surgeon's preference and expertise.
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Affiliation(s)
- Georgios Koimtzis
- Department of Oesophageal and Gastric Surgery, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK
| | - Leandros Stefanopoulos
- Department of Electrical and Computer Engineering, Northwestern University, 633 Clark St., Evanston, IL 60208, USA;
| | - Georgios Geropoulos
- Western General Hospital, NHS Lothian, Crewe Road South, Edinburgh EH4 2XU, UK;
| | - Christopher G. Chalklin
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; (C.G.C.); (I.K.); (A.A.A.)
| | - Ioannis Karniadakis
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; (C.G.C.); (I.K.); (A.A.A.)
| | - Awad A. Alawad
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; (C.G.C.); (I.K.); (A.A.A.)
| | - Vyron Alexandrou
- Urology Department, General Hospital of Thessaloniki “G. Gennimata-Agios Dimitrios”, Elenis Zografou 2, 54634 Thessaloniki, Greece;
| | - Nikos Tteralli
- Department of General Surgery, North Hampshire NHS Foundation Trust, Basingstoke RG24 9NA, UK;
| | - Eliot Carrington-Windo
- Department of General Surgery, Grange University Hospital, Caerleon Road, Llanfrechfa, Cwmbran NP44 8YN, UK;
| | | | - Kyriakos Psarras
- School of Medicine, Second Surgical Propedeutic Department, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece;
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Bhattacharya P, Hussain MI, Zaman S, Randle S, Tanveer Y, Faiz N, Sarma DR, Peravali R. Delorme's vs. Altemeier's in the management of rectal procidentia: systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:454. [PMID: 38041773 DOI: 10.1007/s00423-023-03181-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/15/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Rectal prolapse is a distressing condition for patients and no consensus exists on optimal surgical management. We compared outcomes of two common perineal operations (Delorme's and Altemeier's) used in the treatment of rectal prolapse. METHODS A systematic search of multiple electronic databases was conducted. Peri- and post-operative outcomes following Delorme's and Altemeier's procedures were extracted. Primary outcomes included recurrence rate, anastomotic dehiscence rate and mortality rate. The secondary outcomes were total operative time, volume of blood loss, length of hospital stay and coloanal anastomotic stricture formation. Revman 5.3 was used to perform all statistical analysis. RESULTS Ten studies with 605 patients were selected; 286 underwent Altemeier's procedure (standalone), 39 had Altemeier's with plasty (perineoplasty or levatoroplasty), and 280 had Delorme's. Recurrence rate [OR: 0.66; 95% CI [0.44-0.99], P = 0.05] was significantly lower and anastomotic dehiscence [RD: 0.05; 95% CI [0.00-0.09], P = 0.03] was significantly higher in the Altemeier's group. However, sub group analysis of Altemeier's with plasty failed to show significant differences in these outcomes compared with the Delorme's procedure. Length of hospital stay was significantly more following an Altemeier's operation compared with Delorme's [MD: 3.05, 95% CI [0.95 - 5.51], P = 0.004]. No significant difference was found in total operative time, intra-operative blood loss, coloanal anastomotic stricture formation and mortality rates between the two approaches. CONCLUSIONS A direct comparison of two common perineal procedures used in the treatment of rectal prolapse demonstrated that the Altemeier's approach was associated with better outcomes. Future, well-designed high quality RCTs with long-term follow up are needed to corroborate our findings.
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Affiliation(s)
- Pratik Bhattacharya
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK.
| | - Mohammad Iqbal Hussain
- Department of General Surgery, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Shafquat Zaman
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
| | - Sophie Randle
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
| | - Yousaf Tanveer
- Department of General Surgery, Craigavon Area Hospital, Portadown, Northern Ireland, UK
| | - Nameer Faiz
- Department of General Surgery, The Dudley Group NHS Trust, Russells Hall Hospital, Dudley, West Midlands, UK
| | - Diwakar Ryali Sarma
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
| | - Rajeev Peravali
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
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Oruc M, Erol T. Current diagnostic tools and treatment modalities for rectal prolapse. World J Clin Cases 2023; 11:3680-3693. [PMID: 37383136 PMCID: PMC10294152 DOI: 10.12998/wjcc.v11.i16.3680] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/25/2023] [Indexed: 06/02/2023] Open
Abstract
Rectal prolapse is a circumferential, full-thickness protrusion of the rectum through the anus. It is a rare condition, and only affects 0.5% of the general population. Multiple treatment modalities have been described, which have changed significantly over time. Particularly in the last decade, laparoscopic and robotic surgical approaches with different mobilization techniques, combined with medical therapies, have been widely implemented. Because patients have presented with a wide range of complaints (ranging from abdominal discomfort to incomplete bowel evacuation, mucus discharge, constipation, diarrhea, and fecal incontinence), understanding the extent of complaints and ruling out differential diagnoses are essential for choosing a tailored surgical procedure. It is crucial to assess these additional symptoms and their severities using preoperative scoring systems. Additionally, radiological and physiological evaluations may explain some vague symptoms and reveal concomitant pelvic disorders. However, there is no consensus on or standardization of the optimal extent of dissection, type of procedure, and materials used for rectal fixation; this makes providing maximum benefits to patients with minimal complications difficult. Even recent publications and systematic reviews have not recommended the most appropriate treatment options. This review explains the appropriate diagnostic tools for different conditions and summarizes the current treatment approaches based on existing literature and expert opinions.
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Affiliation(s)
- Mustafa Oruc
- Department of General Surgery, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Timucin Erol
- Department of General Surgery, Hacettepe University School of Medicine, Ankara 06100, Turkey
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Moon H, Park Y, Kim M, Lee S. Interaction and main effects of physical and depressive symptoms on quality of life in Korean women seeking care for rectal prolapse: a cross-sectional observational study. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2021; 27:297-306. [PMID: 36311444 PMCID: PMC9328636 DOI: 10.4069/kjwhn.2021.12.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose Rectal prolapse is still a relatively understudied medical condition, especially in women, whereas physical symptoms, depressive symptoms, and quality of life (QOL) in women with pelvic organ prolapse have been steadily studied. This study aimed to examine the interaction and main effects of physical and depressive symptoms on physical and mental QOL of women seeking care for rectal prolapse in Korea. Methods Ninety-two women with rectal prolapse were recruited from a colorectal surgery clinic of a tertiary teaching hospital in Gwangju, Korea. Physical symptoms related to rectal prolapse (pelvic organ prolapse distress, POPD; colorectal-anal distress, CRAD; and urinary distress, UD), depression, and QOL were measured. The data were analyzed using descriptive statistics, Pearson correlation coefficient, and two-way analysis of variance. Results The interaction between POPD symptoms and depressive symptoms (F=4.51, p=.037) affected physical QOL. The interaction between POPD (F=9.66, p=.003) and CRAD symptoms (F=7.48, p=.008), respectively, and depressive symptoms affected mental QOL. Depressive symptoms had a significant main effect on the physical QOL in the CRAD (F=6.22, p=.014) and UD (F=6.01, p=.016) groups and on mental QOL in the UD group (F=24.54, p<.001). Conclusion Physical and depressive symptoms should be considered together to improve the QOL in women with rectal prolapse. Nursing interventions and medical treatments to decrease rectal prolapse-related physical and depressive symptoms are required to improve QOL in women with symptomatic rectal prolapse.
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Affiliation(s)
- Hee Moon
- Department of Nursing, Sunchon National University, Sunchon, Korea
| | - Youngrye Park
- Department of Nursing, Kunsan National University, Gunsan, Korea
| | - Mili Kim
- Chonnam National University Hospital, Gwangju, Korea
| | - Seonah Lee
- College of Nursing, Chonnam National University, Gwangju, Korea
- Corresponding author: Seonah Lee College of Nursing, Chonnam National University, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-530-4945 E-mail:
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Wang JT, Miao YD, Guan QL. Comment on "Diagnostic approach to faecal incontinence: What test and when to perform?". World J Gastroenterol 2021; 27:5622-5624. [PMID: 34588756 PMCID: PMC8433609 DOI: 10.3748/wjg.v27.i33.5622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/21/2021] [Accepted: 08/20/2021] [Indexed: 02/06/2023] Open
Abstract
We recently read with interest the article "Diagnostic approach to faecal incontinence: What test and when to perform?". This is a comprehensive and practical review, which has particular significance for guiding clinicians to improve the examination strategy. Although we appreciate their work very much, based on the in-depth analysis of this research, we found some detailed problems in the article and will give our comments in this letter. If the author can further improve the relevant research, it will be valuable.
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Affiliation(s)
- Jiang-Tao Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Yan-Dong Miao
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Quan-Lin Guan
- Department of Oncology, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou 730000, Gansu Province, China
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Wang J, Li H, Ma X, Du G, Ma J, Ren X, Zhang F, Dong X, Zhao H, Ren C. A new modified Gant-Miwa-Thiersch combined with submucosal and perirectal sclerosant injection procedure for full-thickness rectal prolapse in elderly women: clinical analysis of 34 cases. BMC Surg 2021; 21:284. [PMID: 34090388 PMCID: PMC8180061 DOI: 10.1186/s12893-021-01284-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Full-thickness rectal prolapse (FTRP) frequently occurs in elderly women, and more than 100 surgical procedures have been proposed to restore FTRP. The Gant-Miwa-Thiersch (GMT) procedure is the most used treatment in China. However, the recurrence rate of FTRP post-GMT, which is as high as 23.8%, is concerning. We described a new modified GMT combined with internal and external rectal sclerosant injection (nmGMTSI) procedure to address this problem. METHODS The nmGMTSI was performed under spinal anesthesia in 34 frail, elderly female patients with FTRP. The surgical results of FTRP were assessed. Fecal incontinence and constipation were evaluated using the Wexner score, and anal canal rest pressure (ACRP), maximum anal systolic pressure (MASP), anorectal sensation thresholds (AST), and maximum rectal tolerance (MRT) using anorectal manometry preoperatively and postoperatively. The causes of recurrence and complications were analyzed. RESULTS All patients were cured according to the clinical cure standard. The perioperative Wexner fecal incontinence score (WFIS) was 10.3 ± 3.31, which became 3.7 ± 2.43 (P < 0.0001) postoperatively. The perioperative ACRP was 2.0 ± 0.56 kPa, which became 8.5 ± 2.25 kPa (P < 0.0001) postoperatively. The perioperative MASP was 4.5 ± 1.16 kPa, which became 18.6 ± 2.50 kPa (P < 0.0001) postoperatively. However, no significant difference was observed between the preoperative and postoperative Wexner constipation scores (WCS) (17.3 ± 2.25 vs. 15.4 ± 2.89, P = 0.1047). The perioperative and postoperative AST were 38.1 ± 5.34 mL and 23.5 ± 3.61 mL, respectively (P = 0.0002). The maximum rectal tolerance (MRT) was 157.1 ± 16.73 mL, which became 121.2 ± 12.45 mL postoperatively (P = 0.0009). The patients developed no serious postoperative complications. The total relapse rate after nmGMTSI was 2.9% in the median two years follow-up period. The most common cause of relapse after nmGMTSI was the removal of infected threads used in the Thiersch procedure. CONCLUSION The benefits of nmGMTSI include low rates of recurrence, complications, and mortality, cost-effectiveness, wide adaptation, minimal invasiveness, and technical simplicity. Hence, it should be considered the first option for the treatment of FTRP in frail elderly women.
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Affiliation(s)
- Jinxi Wang
- Shanxi Bethune Hospital, Taiyuan, 030012, People's Republic of China
| | - Huiyu Li
- Shanxi Bethune Hospital, Taiyuan, 030012, People's Republic of China
| | - Xiaoming Ma
- Burn Treatment Center of Shanxi Province, Tisco General Hospital, Taiyuan, 030000, People's Republic of China
| | - Gang Du
- Shanxi Bethune Hospital, Taiyuan, 030012, People's Republic of China
| | - Jun Ma
- Shanxi Bethune Hospital, Taiyuan, 030012, People's Republic of China
| | - Xiaojing Ren
- Shanxi Bethune Hospital, Taiyuan, 030012, People's Republic of China
| | - Fang Zhang
- Shanxi Bethune Hospital, Taiyuan, 030012, People's Republic of China
| | - Xiushan Dong
- Shanxi Bethune Hospital, Taiyuan, 030012, People's Republic of China
| | - Haoliang Zhao
- Shanxi Bethune Hospital, Taiyuan, 030012, People's Republic of China
| | - Chongren Ren
- Shanxi Bethune Hospital, Taiyuan, 030012, People's Republic of China. .,Department of Colorectal Surgery, Shanxi Bethune Hospital, Longcheng Street 99, Taiyuan, 030012, People's Republic of China.
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