Skip to main content

Advertisement

SpringerLink
Log in

Outcome of laparoscopic ventral mesh rectopexy for full-thickness external rectal prolapse: a systematic review, meta-analysis, and meta-regression analysis of the predictors for recurrence

  • Review Article
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Laparoscopic ventral mesh rectopexy (LVMR) has proved effective in the treatment of internal and external rectal prolapse. The present meta-analysis aimed to determine the predictive factors of recurrence of full-thickness external rectal prolapse after LVMR.

Methods

An organized, systematic search of electronic databases including PubMed/Medline, Embase, Scopus, and Cochran library was conducted in adherence to PRISMA guidelines. Studies that reported the outcome of LVMR in patients with full-thickness external rectal prolapse were included according to predefined criteria. A meta-regression analysis and sub-group meta-analyses were performed to recognize the patient and technical factors that were associated with higher recurrence rates.

Results

Seventeen studies comprising 1242 patients of a median age of 60 years were included. The median operation time was 122.3 min. Conversion to open surgery was required in 22 (1.8%) patients. The weighted mean complication rate across the studies was 12.4% (95% CI 8.4–16.4) and the weighted mean rate of recurrence of full-thickness external rectal prolapse was 2.8% (95% CI 1.4–4.3). The median follow-up duration was 23 months. Male gender (SE = 0.018, p = 0.008) and length of the mesh (SE = − 0.007, p = 0.025) were significantly associated with full-thickness recurrence of rectal prolapse. The weighted mean rates of improvement in fecal incontinence and constipation after LVMR were 79.3% and 71%, respectively.

Conclusion

LVMR is an effective and safe option in treatment of full-thickness external rectal prolapse with low recurrence and complication rates. Male patients and length of the mesh may potentially have a significant impact on recurrence of rectal prolapse after LVMR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Gourgiotis S, Baratsis S (2007) Rectal prolapse. Int J Colorectal Dis 22(3):231–243

    Article  PubMed  Google Scholar 

  2. Emile SH, Elfeki H, Shalaby M, Sakr A, Sileri P, Wexner SD (2017) Perineal resectional procedures for the treatment of complete rectal prolapse: a systematic review of the literature. Int J Surg 46:146–154. https://doi.org/10.1016/j.ijsu.2017.09.005

    Article  PubMed  Google Scholar 

  3. D’Hoore A, Cadoni R, Penninckx F (2004) Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg 91(11):1500–1505

    Article  PubMed  Google Scholar 

  4. Faucheron JL, Trilling B, Girard E, Sage PY, Barbois S, Reche F (2015) Anterior rectopexy for full-thickness rectal prolapse: technical and functional results. World J Gastroenterol 21(16):5049–5055

    Article  PubMed  PubMed Central  Google Scholar 

  5. Emile SH, Elfeki H, Youssef M, Farid M, Wexner SD (2017) Abdominal rectopexy for the treatment of internal rectal prolapse: a systematic review and meta-analysis. Colorectal Dis 19(1):O13–O24. https://doi.org/10.1111/codi.13574

    Article  CAS  PubMed  Google Scholar 

  6. Consten EC, van Iersel JJ, Verheijen PM, Broeders IA, Wolthuis AM, D’Hoore A (2015) Long-term outcome after laparoscopic ventral mesh rectopexy: an observational study of 919 consecutive patients. Ann Surg 262(5):742–747. https://doi.org/10.1097/sla.0000000000001401 discussion 747–748

    Article  PubMed  Google Scholar 

  7. Mathew MJ, Parmar AK, Reddy PK (2014) Mesh erosion after laparoscopic posterior rectopexy: a rare complication. J Minim Access Surg. 1(1):40–41. https://doi.org/10.4103/0972-9941.124473

    Article  Google Scholar 

  8. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 6(6):e1000097. https://doi.org/10.1371/journal.pmed1000097

    Article  PubMed  PubMed Central  Google Scholar 

  9. National Institute for Health and Clinical Excellence. NICE clinical guidelines, Appendix 4 Quality of case series form. https://www.nice.org.uk/guidance/cg3/documents/appendix-4-quality-of-case-series-form2

  10. Scottish Intercollegiate Guidelines Network (SIGN) guidelines, methodology checklist 3. http://www.sign.ac.uk/methodology/checklists.html

  11. Boons P, Collinson R, Cunningham C, Lindsey I (2010) Laparoscopic ventral rectopexy for external rectal prolapse improves constipation and avoids de novo constipation. Colorectal Dis 12(6):526–532. https://doi.org/10.1111/j.1463-1318.2009.01859.x

    Article  CAS  PubMed  Google Scholar 

  12. Wijffels N, Cunningham C, Dixon A, Greenslade G, Lindsey I (2011) Laparoscopic ventral rectopexy for external rectal prolapse is safe and effective in the elderly. Does this make perineal procedures obsolete? Colorectal Dis 13(5):561–566. https://doi.org/10.1111/j.1463-1318.2010.02242.x

    Article  CAS  PubMed  Google Scholar 

  13. Faucheron JL, Voirin D, Riboud R, Waroquet PA, Noel J (2012) Laparoscopic anterior rectopexy to the promontory for full-thickness rectal prolapse in 175 consecutive patients: short- and long-term follow-up. Dis Colon Rectum 55:660–665

    Article  PubMed  Google Scholar 

  14. Formijne Jonkers HA, Maya A, Draaisma WA, Bemelman WA, Broeders IA, Consten EC, Wexner SD (2014) Laparoscopic resection rectopexy versus laparoscopic ventral rectopexy for complete rectal prolapse. Tech Coloproctol 18(7):641–646. https://doi.org/10.1007/s10151-014-1122-3

    Article  CAS  PubMed  Google Scholar 

  15. Mehmood RK, Parker J, Bhuvimanian L, Qasem E, Mohammed AA, Zeeshan M, Grugel K, Carter P, Ahmed S (2014) Short-term outcome of laparoscopic versus robotic ventral mesh rectopexy for full-thickness rectal prolapse. Is robotic superior? Int J Colorectal Dis 29(9):1113–1118. https://doi.org/10.1007/s00384-014-1937-4

    Article  PubMed  Google Scholar 

  16. Bjerke T, Mynster T (2014) Laparoscopic ventral rectopexy in an elderly population with external rectal prolapse: clinical and anal manometric results. Int J Colorectal Dis 29(10):1257–1262. https://doi.org/10.1007/s00384-014-1960-5

    Article  PubMed  Google Scholar 

  17. Randall J, Smyth E, McCarthy K, Dixon AR (2014) Outcome of laparoscopic ventral mesh rectopexy for external rectal prolapse. Colorectal Dis 16(11):914–919. https://doi.org/10.1111/codi.12741

    Article  CAS  PubMed  Google Scholar 

  18. Gosselink MP, Joshi H, Adusumilli S, van Onkelen RS, Fourie S, Hompes R, Jones OM, Cunningham C, Lindsey I (2015) Laparoscopic ventral rectopexy for faecal incontinence: equivalent benefit is seen in internal and external rectal prolapse. J Gastrointest Surg. 19(3):558–563. https://doi.org/10.1007/s11605-014-2696-9

    Article  CAS  PubMed  Google Scholar 

  19. Chandra A, Kumar S, Maurya AP, Gupta V, Gupta V (2016) Laparoscopic ventral mesh rectopexy for complete rectal prolapse: a retrospective study evaluating outcomes in North Indian population. World J Gastrointest Surg 8(4):321–325. https://doi.org/10.4240/wjgs.v8.i4.321

    Article  PubMed  PubMed Central  Google Scholar 

  20. Rautio T, Mäkelä-Kaikkonen J, Vaarala M, Kairaluoma M, Kössi J, Carpelan-Holmström M, Salmenkylä S, Ohtonen P, Mäkelä J (2016) Laparoscopic ventral rectopexy in male patients with external rectal prolapse is associated with a high reoperation rate. Tech Coloproctol 20(10):715–720. https://doi.org/10.1007/s10151-016-1528-1

    Article  CAS  PubMed  Google Scholar 

  21. Lundby L, Iversen LH, Buntzen S, Wara P, Høyer K, Laurberg S (2016) Bowel function after laparoscopic posterior sutured rectopexy versus ventral mesh rectopexy for rectal prolapse: a double-blind, randomised single-centre study. Lancet Gastroenterol Hepatol. 1(4):291–297. https://doi.org/10.1016/S2468-1253(16)30085-1

    Article  PubMed  Google Scholar 

  22. Emile SH, Elbanna H, Youssef M, Thabet W, Omar W, Elshobaky A, Abd El-Hamed TM, Farid M (2017) Laparoscopic ventral mesh rectopexy vs Delorme’s operation in management of complete rectal prolapse: a prospective randomized study. Colorectal Dis 19(1):50–57. https://doi.org/10.1111/codi.13399

    Article  CAS  PubMed  Google Scholar 

  23. Luglio G, Tarquini R, Giglio MC, Sollazzo V, Peltrini R, Sacco M, Spiezio G, Amato B, De Palma GD, Bucci L (2017) Ventral mesh rectopexy versus conventional suture technique: a single-institutional experience. Aging Clin Exp Res 29(Suppl 1):79–82. https://doi.org/10.1007/s40520-016-0672-9

    Article  PubMed  Google Scholar 

  24. Fu CW, Stevenson AR (2017) Risk factors for recurrence after laparoscopic ventral rectopexy. Dis Colon Rectum 60(2):178–186. https://doi.org/10.1097/DCR.0000000000000710

    Article  PubMed  Google Scholar 

  25. Madbouly KM, Youssef M (2018) Laparoscopic ventral rectopexy versus laparoscopic wells rectopexy for complete rectal prolapse: long-term results. J Laparoendosc Adv Surg Tech A. 28(1):1–6. https://doi.org/10.1089/lap.2017.0012

    Article  PubMed  Google Scholar 

  26. Chandra A, Singh P, Kumar S, Chopra N, Gupta V, Joshi P, Gupta V (2018) Laparoscopic ventral rectopexy: a viable option in procidentia with redundant sigmoid—an Indian perspective. J Minim Access Surg. 14(4):304–310. https://doi.org/10.4103/jmas.jmas_106_17

    Article  PubMed  PubMed Central  Google Scholar 

  27. Adeyemo D (2013) Mesh fistulation into the rectum after laparoscopic ventral mesh rectopexy. Int J Surg Case Rep. 5(3):152–154

    Article  PubMed  PubMed Central  Google Scholar 

  28. Blaker K, Anandam JL (2017) Functional disorders: rectoanal intussusception. Clin Colon Rectal Surg 30(1):5–11

    Article  PubMed  PubMed Central  Google Scholar 

  29. Dvorkin LS, Gladman MA, Scott SM, Williams NS, Lunniss PJ (2005) Rectal intussusception: a study of rectal biomechanics and visceroperception. Am J Gastroenterol 100(7):1578–1585

    Article  PubMed  Google Scholar 

  30. Rakinic J. Rectal prolapse. Medscape. https://emedicine.medscape.com/article/2026460-overview#a7. Accessed on Dec 4, 2018/

  31. Owais AE, Sumrien H, Mabey K, McCarthy K, Greenslade GL, Dixon AR (2014) Laparoscopic ventral mesh rectopexy in male patients with internal or external rectal prolapse. Colorectal Dis 16(12):995–1000. https://doi.org/10.1111/codi.12763

    Article  CAS  PubMed  Google Scholar 

  32. Badrek-Al Amoudi AH, Greenslade GL, Dixon AR (2013) How to deal with complications after laparoscopic ventral mesh rectopexy: lessons learnt from a tertiary referral centre. Colorectal Dis 15:707–712

    Article  CAS  PubMed  Google Scholar 

  33. Mackenzie H, Dixon AR (2014) Proficiency gain curve and predictors of outcome for laparoscopic ventral mesh rectopexy. Surgery 156:158–167

    Article  PubMed  Google Scholar 

  34. Hwang YH (2013) Role of the Delorme procedure for rectal prolapse in young patients. Ann Coloproctol 29:41

    Article  PubMed  PubMed Central  Google Scholar 

  35. Shalaby M, Polisca P, Missori G, Sileri P (2016) Hiatal hernia, mitral valve prolapse and defecatory disorders: An underlying rectal prolapse? Tech Coloproctol 20(5):337–338. https://doi.org/10.1007/s10151-016-1442-6

    Article  CAS  PubMed  Google Scholar 

  36. Lee UJ, Kerkhof MH, van Leijsen SA, Heesakkers JP (2017) Obesity and pelvic organ prolapse. Curr Opin Urol 27(5):428–434. https://doi.org/10.1097/MOU.0000000000000428

    Article  PubMed  Google Scholar 

  37. Cuicchi D, Lombardi R, Cariani S, Leuratti L, Lecce F, Cola B (2013) Clinical and instrumental evaluation of pelvic floor disorders before and after bariatric surgery in obese women. Surg Obes Relat Dis 9:69–75

    Article  PubMed  Google Scholar 

  38. Mercer-Jones MA, D’Hoore A, Dixon AR, Lehur P, Lindsey I, Mellgren A, Stevenson AR (2014) Consensus on ventral rectopexy: report of a panel of experts. Colorectal Dis 16(2):82–88. https://doi.org/10.1111/codi.1241

    Article  CAS  PubMed  Google Scholar 

  39. Balla A, Quaresima S, Smolarek S, Shalaby M, Missori G, Sileri P (2017) Synthetic versus biological mesh-related erosion after laparoscopic ventral mesh rectopexy: a systematic review. Ann Coloproctol. 33(2):46–51. https://doi.org/10.3393/ac.2017.33.2.46

    Article  PubMed  PubMed Central  Google Scholar 

  40. Formijne Jonkers HA, van de Haar HJ, Draaisma WA, Heggelman BG, Consten EC, Broeders IA (2012) The optimal strategy for proximal mesh fixation during laparoscopic ventral rectopexy for rectal prolapse: an ex vivo study. Surg Endosc 26(8):2208–2212. https://doi.org/10.1007/s00464-012-2161-3

    Article  PubMed  Google Scholar 

  41. Pucher PH, Mayo D, Dixon AR, Clarke A, Lamparelli MJ (2017) Learning curves and surgical outcomes for proctored adoption of laparoscopic ventral mesh rectopexy: cumulative sum curve analysis. Surg Endosc 31(3):1421–1426. https://doi.org/10.1007/s00464-016-5132-2

    Article  PubMed  Google Scholar 

  42. Mercer-Jones MA, Brown SR, Knowles CH, Williams AB (2017) Position Statement by The Pelvic Floor Society on behalf of The Association of Coloproctology of Great Britain and Ireland on the use of mesh in ventral mesh rectopexy (VMR). Colorectal Dis. https://doi.org/10.1111/codi.13893

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, PO: 35516, 60 Elgomhuoria Street, Mansoura, Egypt

    Sameh Hany Emile, Hossam Elfeki, Mostafa Shalaby & Ahmad Sakr

  2. Department of Surgery, Aarhus University Hospital, Aarhus, Denmark

    Hossam Elfeki

  3. Department of General Surgery, University of Rome Tor Vergata, Rome, Italy

    Mostafa Shalaby & Pierpaolo Sileri

  4. Colorectal Surgery Department, Yonsei University College of Medicine, Seoul, South Korea

    Ahmad Sakr

  5. Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA

    Steven D. Wexner

Authors
  1. Sameh Hany Emile
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hossam Elfeki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mostafa Shalaby
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ahmad Sakr
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pierpaolo Sileri
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Steven D. Wexner
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SHE designed the study. SHE, HE, MS, and AS participated in data collection and analysis, writing, and drafting of the manuscript. PS participated in data interpretation, drafting, and critical revision of the manuscript. SDW reviewed the collected results on regular basis and participated in drafting and critical revision of the manuscript.

Corresponding author

Correspondence to Sameh Hany Emile.

Ethics declarations

Disclosures

Sameh Emile, Hossam Elfeki, Mostafa Shalaby, Ahmad Sakr, Pierpaolo Sileri, and Steven D Wexner do not have any relevant financial conflicts of interests to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Emile, S.H., Elfeki, H., Shalaby, M. et al. Outcome of laparoscopic ventral mesh rectopexy for full-thickness external rectal prolapse: a systematic review, meta-analysis, and meta-regression analysis of the predictors for recurrence. Surg Endosc 33, 2444–2455 (2019). https://doi.org/10.1007/s00464-019-06803-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-019-06803-0

Keywords

Search

Navigation