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Recurrence of rectal prolapse following rectopexy: a pooled analysis of 532 patients
Author(s) -
Bishawi M.,
Foppa C.,
Tou S.,
Bergamaschi R.
Publication year - 2016
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.13160
Subject(s) - medicine , rectal prolapse , univariate analysis , surgery , multivariate analysis , constipation , rectum
Aim The study was designed to address the unanswered question of the influence of the extent of rectal mobilization, the type of rectal fixation and the surgical access (open vs laparoscopic) on recurrence rates following abdominal surgery for full‐thickness rectal prolapse (FTRP). Method Individual patient data were pooled and data merging was performed following comparison of variable definitions to ensure similarity in definitions. Recurrence after rectopexy was defined as the presence of FTRP on physical examination. The impact of categorical factors on recurrence was assessed using Fisher's exact and the chi‐squared tests. Recurrence‐free survival curves were generated for patients and differences in time to recurrence were compared using the log rank test. Factors passing univariate screening with a P value < 0.1 were included in a multivariate model. Results After data matching and merging, 532 patients were included. The duration of follow‐up ranged from 12 to 235 months. There were 46 (8.6%) recurrences at a median follow‐up of 60 months. Mean age was 53.6 ± 17 years, 359 (67.5%) were female, the mean length of external prolapse was 6.3 ± 4 cm, and previous abdominal surgery had taken place in 33.7%. Four variables were identified on initial univariate screening as being related to recurrence. They included a history of incontinence ( P = 0.09), constipation ( P = 0.018), the extent of rectal mobilization ( P = 0.004) and the role of sigmoid resection ( P = 0.057). Using multivariate analysis, only the degree of mobilization was independently associated with recurrence ( P = 0.026). Conclusion Circumferential rectal mobilization during rectopexy was associated with a decreased long‐term recurrence rate. The type of rectal fixation and the type of surgical access did not influence recurrence.