<scp>PROSPER</scp>: a randomised comparison of surgical treatments for rectal prolapse

Senapati, Asha; Gray, Richard; Middleton, LJ; Harding, James J.; Hills, Robert Kerrin; Armitage, N. C.; Buckley, Laura; Northover, J. M. A.

doi:10.1111/codi.12177

Cited by 237 publications

(203 citation statements)

References 17 publications

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“…One patient died (1.2%). Other studies have found higher mortality, and some have found lower (3,11). considering the fact that many patients were old, we believe that complication and mortality rates found in this study are acceptable.…”

Section: Discussionsupporting

confidence: 52%

Laparoscopic posterior mesh rectopexy for rectal prolapse is a safe procedure in older patients: A prospective follow-up study

2015

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Background and aims: The aim of this study is to examine the clinical and functional outcome of laparoscopic posterior rectopexy in a consecutive series of adult patients with full-thickness rectal prolapse. Material and methods: Preoperative data on demography, life-style practices, medication, comorbidity, and previous surgery for rectal prolapse were ascertained from patient charts. Information on operative procedure, and pre- and postoperative complications were recorded. Short- and long-term follow-up were done after a median of 60 days and 2 years after surgery. Results: Between 1 February 2009 to 1 June 2012, 81 laparoscopic posterior rectopexies were done. Male-to-female ratio was 4:77, median age 73 [57–80.5] years and median ASA Grade 2. Conversion to open surgery was done in 6.2%, the median operating time was 82 min [66 - 102] and median length of hospital stay was 2 days [2–5.7]. Minor and major complications were seen in 5.3% and 14.8%, respectively. The 30-day mortality rate was 1.2%. Constipation or incontinence improved or disappeared in 65.2% and 74.4%, respectively. The cumulated recurrence rate was 11.1% after a median observation time of 2 years. Conclusion: Laparoscopic posterior rectopexy is a safe and well-tolerated procedure in older patients and can be done with acceptable complications and recurrence rates and short hospital stays. Laparoscopic posterior rectopexy seems to improve bowel function in many patients.

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Section: Discussionsupporting

confidence: 52%

Laparoscopic posterior mesh rectopexy for rectal prolapse is a safe procedure in older patients: A prospective follow-up study

2015

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“…Since that time, over 100 different surgical procedures have been proposed for the management of this condition [3,4]. Although the majority of these procedures are now of only historical interest, many different techniques are still being used today.…”

Section: Introductionmentioning

confidence: 99%

Surgical treatments for rectal prolapse: how does a perineal approach compare in the laparoscopic era?

et al. 2014

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Background Patients with rectal prolapse often have significant comorbidities that lead surgeons to select a perineal resection for treatment despite a reported higher recurrence rate over abdominal approaches. There is a lack of data to support this practice in the laparoscopic era. The objective of this study was to evaluate if risk-adjusted morbidity of perineal surgery for rectal prolapse is actually lower than laparoscopic surgery.Design A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database as performed for patients undergoing surgical treatment of rectal prolapse between 2005 and 2011. Outcomes were analyzed according to procedure-type: laparoscopic rectopexy (LR), laparoscopic resection/rectopexy (LRR), open rectopexy (OR), open resection/rectopexy (ORR), and perineal resection (PR). A multivariate logistic regression was used to compare riskadjusted morbidity and mortality between each procedure. Main outcome measures were 30-day morbidity and mortality.Results Among 3,254 cases sampled, a laparoscopic approach was used in 22 %, an open abdominal approach in 30 %, and PR in 48 %. Patients undergoing PR were older (76) and had a higher ASA (3) compared to laparoscopic (58, 2) and open abdominal procedures (58, 2). Risk-adjusted mortality could not be assessed due to a low overall incidence of mortality (0.01 %). Overall morbidity was 9.3 %. ORR was associated with a higher risk-adjusted morbidity compared to PR (OR: 1.89 CI (1.19-2.99), p = 0.03). There were no significant differences in risk adjusted morbidity found between LR and LRR compared to PR p = 0.18;), p = 0.18). Laparoscopic cases averaged 27 min longer than open cases (p\0.001).Conclusion Laparoscopic rectal prolapse surgery has comparable morbidity and mortality to perineal surgery. A randomized trial is indicated to validate these findings and to assess recurrence rates and functional outcomes.The Delorme procedure for the surgical treatment of rectal prolapse was first described by the French surgeon Edmond Delorme in 1900 [1,2]. Since that time, over 100 different surgical procedures have been proposed for the management of this condition [3,4]. Although the majority of these procedures are now of only historical interest, many different techniques are still being used today. Procedures to address rectal prolapse can broadly be split into two main approaches-abdominal and perineal. The primary goals of the operation are to correct the prolapse, alleviate preoperative discomfort, and to prevent or improve fecal incontinence or constipation [5]. Traditionally, a perineal approach has been considered the operation of choice in any elderly or high-risk patient, because it was associated with lower perioperative morbidity, decreased pain, and a shorter length of hospital stay [6]. However, advances in minimally invasive techniques have called into question the optimal procedure for rectal prolapse, especially when considering long-term outcomes such as recurrence or an...

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“…Abdominal operations seem to result in lower recurrence rates but there are no randomized controlled trials substantiating this. 5,6 Perineal procedures avoid laparotomy/laparoscopy, and therefore, may have a lower operative risk and morbidity. They may, therefore, be more suitable for older or high-risk patients with a relevant co-morbidity, although again there are no adequately powered RCTs to back these recommendations up.…”

Section: Operation Proceduresmentioning

confidence: 99%

Surgical Approaches for Rectal Prolapse and their Comparative Study

Shaikh¹

2015

WJOLS

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Rectal prolapse is a distressing condition often affecting elderly patients. Open rectopexy has a proven track record in the treatment of this condition but may be complicated by significant morbidity. The benign nature of the disease and reduced pain and pulmonary complications of the laparoscopic approach makes this an attractive operation in this patient group. Laparoscopic prosthesis fixation rectopexy and lateral ligament suspension with and without colectomy have been described with low recurrence rates, good patient acceptability, symptom improvement, on both radiological and physiological assessments. Currently, the laparoscopic approach with ventral mesh rectopexy or resection rectopexy is the two most commonly used techniques. As high quality evidence is missing, an individualized approach is recommend for every patient considering age, individual health status and the underlying morphological and functional disorders.

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PROSPER: a randomised comparison of surgical treatments for rectal prolapse

Cited by 237 publications

References 17 publications

Laparoscopic posterior mesh rectopexy for rectal prolapse is a safe procedure in older patients: A prospective follow-up study

Laparoscopic posterior mesh rectopexy for rectal prolapse is a safe procedure in older patients: A prospective follow-up study

Surgical treatments for rectal prolapse: how does a perineal approach compare in the laparoscopic era?

Surgical Approaches for Rectal Prolapse and their Comparative Study

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