EP643 - Long-term Outcomes of Surgical Treatments for Rectal Prolapse: A Systematic Review and Meta-analysis

ePoster Presenter(s)

• 

  George L. Wu, B.S.

  Research Assistant
  Surgery Group of Los Angeles
  Los Angeles, CA, United States

  Disclosure information not submitted.

Author(s)

• AS

  Andrea Paola P. Solis Pazmino, 1804664892

  Surgery Resident
  Surgery Group Los Angeles
  Porto Alegre, Rio Grande do Sul, Brazil

  Disclosure information not submitted.
• SR

  Sameh Rizkalla, MBBCh, MS, MD, FACS

  Project Scientist
  Cleveland Clinic Florida
  Weston, Florida, United States

  Disclosure information not submitted.
• MB

  Moshe Barnajian, n/a

  Colorectal Surgery
  Surgery Group Los Angeles
  Los Angeles, California, United States

  Disclosure information not submitted.
• JP

  Jamila Piri, B.S.

  Research Assistant
  Surgery Group of LA Research Foundation
  Los Angeles, California, United States

  Disclosure information not submitted.
• KL

  Kristina La, BS

  research fellow
  SGLA
  Los Angeles, California, United States

  Disclosure information not submitted.
• 

  Nir Horesh, MD

  Resident Physician
  Cleveland Clinic Florida
  Tel Aviv University
  Weston, FL, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• 

  Yosef Nasseri, MD, FACS, FASCRS

  General and colorectal surgeron
  Cedar-Sinai Medical Center
  Cedars-Sinai Medical Center
  Los Angeles, CA, United States

  Disclosure information not submitted.

Purpose/Background: The key outcomes influencing surgical decision-making for rectal prolapse are recurrence and improvement in fecal incontinence and constipation. Although the durability of rectal prolapse surgery is critical, the long-term effectiveness of the available procedures remains uncertain.

Methods/Interventions: We conducted a PRISMA-compliant systematic review and network meta-analysis of studies reporting a minimum of 5 years of follow-up after rectal prolapse surgery. Searches were performed in PubMed, Cochrane, and Web of Science. Eligible studies included adults undergoing surgical treatment of rectal prolapse and reported long-term follow-up data on recurrence and other outcomes. Pairwise and network meta-analyses were conducted using random-effects models. The primary outcome was recurrence, and secondary outcomes included improvement in fecal incontinence and constipation. Risk of bias was assessed using ROBINS-I for non-randomized studies and RoB 2 for the randomized trial.

Results/Outcomes: Fifteen studies comprising 1,790 patients were included, with a median follow-up of 7.2 years (range, 5-15 years). The evidence network connected four procedures: ventral mesh rectopexy (VMR; 7 arms, n = 1,468), suture rectopexy (6 arms, n = 766), Delorme's procedure (6 arms, n = 185), and resection rectopexy (3 arms, n = 88). On long-term follow-up, the recurrence risk was lowest with VMR. Compared with VMR, recurrence was significantly higher after suture rectopexy (RR = 4.12, 95% CI 1.79-9.45) and Delorme's procedure (RR = 6.10, 95% CI 2.87-12.97), whereas resection rectopexy showed comparable outcomes (RR = 1.78, 95% CI 0.49-6.38). Ranking analysis consistently favored VMR as the most durable procedure. Long-term outcomes for fecal incontinence and constipation did not significantly differ among techniques, although heterogeneity across studies limited certainty.

Conclusion/Discussion: In studies with extended follow-up, VMR demonstrated the lowest recurrence risk and the most durable outcomes. Resection rectopexy achieved comparable results, whereas Suture Rectopexy and Delorme's procedure were associated with substantially higher long-term recurrence. The improvement in fecal incontinence and constipation was similar between the procedures. These findings support VMR as the preferred surgical strategy for rectal prolapse.

Network meta-analysis of recurrence after rectal prolapse surgery
Ranking analysis using P-scores indicated that VMR was consistently the best-performing technique, followed by resection rectopexy, with Delorme's procedure ranking lowest (Figure 4). There was moderate heterogeneity (τ² = 0.36) and no evidence of major inconsistency in local (node-splitting) or global (design-by-treatment) assessments.