Restored pelvic anatomy is preserved after laparoscopic and robot‐assisted ventral rectopexy: MRI‐based 5‐year follow‐up of a randomized controlled trial

Abstract

Aim Our aim was to compare the long-term anatomical outcomes between robot-assisted ventral mesh rectopexy (RVMR) and laparoscopic ventral mesh rectopexy (LVMR) for external or internal rectal prolapse. Method This study is a follow-up of a single-centre randomized controlled trial (RCT). Thirty patients were randomly allocated to RVMR (n = 16) or LVMR (n = 14). The primary end-point was maintenance of the restored pelvic anatomy 5 years after the operation, as assessed by magnetic resonance (MR) defaecography. Secondary outcome measures included the Pelvic Organ Prolapse Quantification (POP-Q) measures and functional results assessed using symptom questionnaires. Results Twenty-six patients (14 RVMR and 12 LVMR) completed the 5-year follow-up and were included in the study. The MRI results, POP-Q measurements and symptom-specific quality of life measures did not differ between the RVMR and LVMR groups. The MRI measurements of the total study population remained unchanged between 3 months and 5 years. In the Pelvic Floor Distress Inventory (PFDI-20), the RVMR group had lower symptom scores (mean 96.0, SD 70.7) than the LVMR group (mean 160.6, SD 58.9; P = 0.004). In the subscales of pelvic organ prolapse (POPDI-6) (mean 23.2, SD 24.3 vs mean 52.4, SD 22.4; P = 0.001) and the Colorectal-Anal Distress Inventory (CRADI-8) (mean 38.4, SD 23.3 vs mean 58.6, SD 25.4; P = 0.009), the patients in the RVMR group had significantly better outcomes. Conclusion After VMR, the corrected anatomy was preserved. There were no clinically significant differences in anatomical results between the RVMR and LVMR procedures 5 years after surgery based on MR defaecography. However, functional outcomes were better after RMVR.

Mesh-related complications and recurrence after ventral mesh rectopexy with synthetic versus biologic mesh: a systematic review and meta-analysis

“…Publication dates varied from 2004 to 2020. Fifteen studies had a retrospective design [ 10 , 12 , 16 , 19 – 21 , 23 – 25 , 27 , 31 , 32 , 34 , 36 , 39 ], 12 had a prospective design [ 1 , 22 , 26 , 28 – 30 , 35 , 37 , 38 , 40 , 41 , 43 ] and four [ 3 , 42 , 44 , 45 ] were RCT’s. In one study, the design was not specified [ 33 ].…”

“…In one study, the design was not specified [ 33 ]. Five studies [ 20 , 36 , 37 , 42 , 43 ] included only patients treated with biologic VMR (Permacol or Biodesign), 24 studies [ 1 , 3 , 10 , 16 , 21 – 26 , 28 – 35 , 38 – 41 , 44 , 45 ] presented only data on synthetic VMR (polypropylene, polyester, ultrapro, other), and three studies included both biologic and synthetic VMR patients [ 12 , 19 , 27 ].…”

“…Median or mean follow-up ranged from 12 to 74 months for synthetic mesh studies and from 12 to 47 months for biologic mesh studies. Eighteen (62%) studies [ 1 , 3 , 10 , 16 , 19 – 22 , 24 , 26 – 31 , 36 , 40 , 44 ] had a median or mean follow-up of 2 years or longer.…”

“…Thirty studies reported on recurrence, including one study that was not considered for further analysis after quality assessment [17]. The remaining 29 studies included 13 studies of low quality [10,16,19,20,22,24,[28][29][30][31][32][33][34], 11 studies of medium quality [1,21,26,27,[35][36][37][38][39][40][41], and five studies as high quality [3,[42][43][44][45] (Table 1).…”

Corrigendum

“…In the Acknowledgements section of [1], the open access funding text was previously incorrect and this section has been removed from the online issue version.…”