Skip to main content

Advertisement

SpringerLink
Log in

Focus on abdominal rectopexy for full-thickness rectal prolapse: meta-analysis of literature

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

Laparoscopic rectopexy to treat full-thickness rectal prolapse has proven short-term benefits, but there are few long-term follow-up and functional outcome data available. Using meta-analysis techniques, this study was designed to evaluate long-term results of open and laparoscopic abdominal procedures to treat full-thickness rectal prolapse in adults.

Methods

A literature review was performed using the National Library of Medicine’s PubMed database. All articles on abdominal rectopexy patients with a follow-up longer than 16 months were considered. The primary end point was recurrence of rectal prolapse, and the secondary end points were improvement in incontinence and constipation. A random effect model was used to aggregate the studies reporting these outcomes, and heterogeneity was assessed.

Results

Eight comparative studies, consisting of a total of 467 patients (275 open and 192 laparoscopic), were included. Analysis of the data suggested that there is no significant difference in recurrence, incontinence and constipation improvement between laparoscopic abdominal rectopexy and open abdominal rectopexy. Considering non-comparative trials, the event rate for recurrence was similar in open and laparoscopic suture rectopexy studies and in open and laparoscopic mesh rectopexy trials. Improvement in constipation after the intervention was not statistically significant except for open mesh repair; postoperative improvement in incontinence was statistically significant after laparoscopic procedures and open mesh rectopexy.

Conclusions

Laparoscopic abdominal rectopexy is a safe and feasible procedure, which may compare equally with the open technique with regard to recurrence, incontinence and constipation. However, large-scale randomized trials, with comparative, strong methodology, are still needed to identify outcome measures accurately.

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
Fig. 7

Similar content being viewed by others

References

  1. Jacobs LK, Lin YJ, Orkin BA (1997) The best operation for rectal prolapse. Surg Clin N Am 77:49–70

    Article  PubMed  CAS  Google Scholar 

  2. Felt-Bersma RJ, Cuesta MA (2001) Rectal prolapse, rectal intussusception, rectocele and solitary ulcer syndrome. Gastroenterol Clin North Am 30:199–222

    Article  PubMed  CAS  Google Scholar 

  3. Roig JV, Buch E, Alós R et al (1998) Anorectal function in patients with complete rectal prolapse: differences between continent and incontinent individuals. Rev Esp Enferm Dig 90:794–805

    PubMed  CAS  Google Scholar 

  4. Brodén B, Snellman B (1968) Procidentia of the rectum: studies with cineradiography. Dis Colon Rectum 11:330–347

    Article  PubMed  Google Scholar 

  5. Kuijpers HC (1992) Treatment of complete rectal prolapse: to narrow, to wrap, to suspend, to fix, to encircle, to plicate or to resect? World J Surg 16:826–830

    Article  PubMed  CAS  Google Scholar 

  6. Nicholls RJ (1994) Rectal prolapse and the solitary ulcer syndrome. Ann Ital Chir 65:157–162

    PubMed  CAS  Google Scholar 

  7. Yakut M, Kaymakcioglu N, Simsek A, Tan A, Sen D (1998) Surgical treatment of rectal prolapse: a retrospective analysis of 94 cases. Int Surg 83:53–55

    PubMed  CAS  Google Scholar 

  8. Kim DS, Tsang CB, Wong WD, Lowry AC, Goldberg SM, Madoff RD (1999) Complete rectal prolapse: evolution of management and results. Dis Colon Rectum 42:460–466

    Article  PubMed  CAS  Google Scholar 

  9. Corman ML (2005) Chapter 17: rectal prolapse, solitary rectal ulcer, syndrome of the descending perineum, and rectocele. In: Corman ML (ed) Colon and rectal surgery, 5th edn. Lippincott Williams and Wilkins, Philadelphia, pp 499–554

    Google Scholar 

  10. Johnson E, Stangeland A, Johannessen HO, Carlsen E (2007) Resection rectopexy for external rectal prolapse reduces constipation and anal incontinence. Scand J Surg 96:56–61

    PubMed  CAS  Google Scholar 

  11. Kariv Y, Delaney CP, Casillas S et al (2006) Long-term outcome after laparoscopic and open surgery for rectal prolapse: a case–control study. Surg Endosc 20:35–42

    Article  PubMed  CAS  Google Scholar 

  12. Demirbas S, Akin ML, Kalemoglu M, Ogun I, Celenk T (2005) Comparison of laparoscopic and open surgery for total rectal prolapse. Surg Today 35:446–452

    Article  PubMed  Google Scholar 

  13. Raftopoulos Y, Senagore AJ, Di Giuro G, Bergamaschi R (2005) Recurrence rates after abdominal surgery for complete rectal prolapse: a multicenter pooled analysis of 643 individual patient data. Dis Colon Rectum 48:1200–1206

    Article  PubMed  Google Scholar 

  14. Solomon M, Young CJ, Eyers AA, Roberts RA (2002) Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse. Br J Surg 89:35–39

    Article  PubMed  CAS  Google Scholar 

  15. Boccasanta P, Venturi M, Reitano MC et al (1999) Laparotomic versus laparoscopic rectopexy in complete rectal prolapse. Dig Surg 16:415–419

    Article  PubMed  CAS  Google Scholar 

  16. Baker R, Senagore AJ, Luchtefeld MA (1995) Laparoscopic assisted versus open resection: rectopexy offers excellent results. Dis Colon Rectum 38:199–201

    Article  PubMed  CAS  Google Scholar 

  17. Salkeld G, Bagia M, Solomon M (2004) Economic impact of laparoscopic versus open abdominal rectopexy. Br J Surg 91:1188–1191

    Article  PubMed  CAS  Google Scholar 

  18. Carter AE (1983) Rectosacral suture fixation for complete prolapse in the elderly, the frail and the demented. Br J Surg 70:522–523

    Article  PubMed  CAS  Google Scholar 

  19. Novell JR, Osborne MJ, Winslet MC, Lewis AA (1994) Prospective randomised trial of Ivalon sponge versus sutured rectopexy for full-thickness rectal prolapse. Br J Surg 81:904–906

    Article  PubMed  CAS  Google Scholar 

  20. Graf W, Karlbom U, Påhlman L, Nilsson S, Ejerblad S (1996) Functional results after abdominal suture rectopexy for rectal prolapse or intussusception. Eur J Surg 162:905–911

    PubMed  CAS  Google Scholar 

  21. Khanna AK, Misra MK, Kumar K (1996) Simplified sutured sacral rectopexy for complete rectal prolapse in adults. Eur J Surg 162:143–146

    PubMed  CAS  Google Scholar 

  22. Briel JW, Schouten WR, Boerma MO (1997) Long-term results of suture rectopexy in patients with fecal incontinence associated with incomplete rectal prolapse. Dis Colon Rectum 40:1228–1232

    Article  PubMed  CAS  Google Scholar 

  23. Llyanage CA, Rathnayake G, Deen KI (2009) A new technique for suture rectopexy without resection for rectal prolapse. Tech Coloproctol 13:27–31

    Article  Google Scholar 

  24. Penfold JC, Hawley PR (1972) Experiences of Ivalon sponge implant for complete rectal prolapse at St. Mark’s Hospital. Br J Sur 59:846–848

    Article  CAS  Google Scholar 

  25. Morgan CN, Porter NH, Klugman DJ (1972) Ivalon sponge in the repair of complete rectal prolapse. Br J Surg 59:841–846

    Article  PubMed  CAS  Google Scholar 

  26. Notaras MJ (1973) The use of Mersilene mesh in rectal prolapse repair. Proc R Soc Med 66:684–686

    PubMed  CAS  Google Scholar 

  27. Launer DP, Fazio VW, Weakley FL et al (1982) The Ripstein procedure: a 16-year experience. Dis Colon Rectum 25:41–45

    Article  PubMed  CAS  Google Scholar 

  28. Holmström B, Brodén G, Dolk A (1986) Results of the Ripstein operation in the treatment of rectal prolapse and internal rectal procidentia. Dis Colon Rectum 29:845–848

    Article  PubMed  Google Scholar 

  29. Roberts PL, Schoetz DJ Jr, Coller JA, Veidenheimer MCL (1988) Ripstein procedure: Lahey clinic experience: 1963–1985. Arch Surg 123:554–557

    Article  PubMed  CAS  Google Scholar 

  30. Keighley MR, Shouler PJ (1984) Abnormalities of colonic function in patients with rectal prolapse and faecal incontinence. Br J Surg 71:892–895

    Article  PubMed  CAS  Google Scholar 

  31. Tjandra JJ, Fazio VW, Church JM, Milsom JW, Oakley JR, Lavery IC (1993) Ripstein procedure is an effective treatment for rectal prolapse without constipation. Dis Colon Rectum 36:501–507

    Article  PubMed  CAS  Google Scholar 

  32. Galili Y, Rabau M (1997) Comparison of polyglycolic acid and polypropylene mesh for rectopexy in the treatment of rectal prolapse. Eur J Surg 163:445–448

    PubMed  CAS  Google Scholar 

  33. Aitola PT, Hiltunen KM, Matikainen MJ (1999) Functional results of operative treatment of rectal prolapse over an 11-year period: emphasis on transabdominal approach. Dis Colon Rectum 42:655–660

    Article  PubMed  CAS  Google Scholar 

  34. Schultz I, Mellgren A, Dolk A, Johansson C, Holmström B (2000) Long-term results and functional outcome after Ripstein rectopexy. Dis Colon Rectum 43:35–43

    Article  PubMed  CAS  Google Scholar 

  35. Mollen RM, Kuijpers HC, van Hoek F (2000) Effects of rectal mobilization and lateral ligaments division on colonic and anorectal function. Dis Colon Rectum 43:1283–1287

    Article  PubMed  CAS  Google Scholar 

  36. Winde G, Reers B, Nottberg H, Berns T, Meyer J, Bünte H (1993) Clinical and functional results of abdominal rectopexy with absorbable mesh-graft for treatment of complete rectal prolapse. Eur J Surg 159:301–305

    PubMed  CAS  Google Scholar 

  37. Kessler H, Jerby BL, Milsom JW (1999) Successful treatment of rectal prolapse by laparoscopic suture rectopexy. Surg Endosc 13:858–861

    Article  PubMed  CAS  Google Scholar 

  38. Bruch HP, Herold A, Schiedeck T, Schwandner O (1999) Laparoscopic surgery for rectal prolapse and outlet obstruction. Dis Colon Rectum 42:1189–1194

    Article  PubMed  CAS  Google Scholar 

  39. Kellokumpu IH, Virozen J, Scheinin T (2000) Laparoscopic repair of rectal prolapse: a prospective study evaluating surgical outcome and changes in symptoms and bowel function. Surg Endosc 14:634–640

    Article  PubMed  CAS  Google Scholar 

  40. Heah SM, Hartely J, Hurley J, Duthie GS, Monson JR (2000) Laparoscopic suture rectopexy without resection is effective treatment for full-thickness rectal prolapse. Dis Colon Rectum 43:638–643

    Article  PubMed  CAS  Google Scholar 

  41. Benoist S, Taffinder N, Gould S, Chang A, Darzi A (2001) Functional results two years after laparoscopic rectopexy. Am J Surg 182:168–173

    Article  PubMed  CAS  Google Scholar 

  42. Wang CC, Ren YX, Hu YZ, Chen J, Pan YL (2007) Treatment for severe rectal prolapse by laparoscopic rectopexy. Zhounghua Wei Chang Wai Ke Za Zhi 10:521–523

    Google Scholar 

  43. Hsu A, Brand MI, Saclarides TJ (2007) Laparoscopic rectopexy without resection: a worthwhile treatment for rectal prolapse in patients without prior constipation. Am Surg 73:858–861

    PubMed  Google Scholar 

  44. Himpens J, Cadière GB, Bruyns J, Vertruyen M (1999) Laparoscopic rectopexy according to Wells. Surg Endosc 13:139–141

    Article  PubMed  CAS  Google Scholar 

  45. Zittel TT, Manncke K, Haug S et al (2000) Functional results after laparoscopic rectopexy for rectal prolapse. J Gastrointest Surg 4:632–641

    Article  PubMed  CAS  Google Scholar 

  46. Lechaux D, Trebuchet G, Siproudhis L, Campion JP (2005) Laparoscopic rectopexy for full-thickness rectal prolapse: a single-institution retrospective study evaluating surgical outcome. Surg Endosc 19:514–518

    Article  PubMed  CAS  Google Scholar 

  47. Douard R, Frileux P, Brunel M, Attal E, Tiret E, Parc R (2003) Functional results after the Orr-Loygue transabdominal rectopexy for complete rectal prolapse. Dis Colon Rectum 46:1089–1096

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  49. Slawik S, Soulsby R, Carter H, Payne H, Dixon AR (2008) Laparoscopic ventral rectopexy, posterior colporrhaphy and vaginal sacrocolpopexy for the treatment of recto-genital prolapse and mechanical outlet obstruction. Colorectal Dis 10:138–143

    PubMed  CAS  Google Scholar 

  50. D’Hoore A, Penninckx F (2006) Laparoscopic ventral recto(colpo)pexy for rectal prolapse: surgical technique and outcome for 109 patients. Surg Endosc 20:1919–1923

    Article  PubMed  Google Scholar 

  51. Marchal F, Bresler L, Ayav A et al (2005) Long-term results of Delorme’s procedure and Orr-Loygue rectopexy to treat complete rectal prolapse. Dis Colon Rectum 48:1785–1790

    Article  PubMed  Google Scholar 

  52. Portier G, Iovino F, Lazorthes F (2006) Surgery for rectal prolapse: Orr-Loygue ventral rectopexy with limited dissection prevents postoperative-induced constipation without increasing recurrence. Dis Colon Rectum 49:1136–1140

    Article  PubMed  Google Scholar 

  53. Van den Esschert JW, van Geloven AA, Vermulst N, Groenedijk AG, de Wit LT, Gerhards MF (2008) Laparoscopic ventral rectopexy for obstructed defecation syndrome. Surg Endosc 22:2728–2732

    Article  PubMed  Google Scholar 

  54. Cristaldi M, Collinson R, Boons P, Cunningham C, Lindsey I (2007) Laparoscopic anterior rectopexy: a new approach that still cures rectal prolapse, but also improves preoperative constipation without inducing new-onset constipation. Dis Colon Rectum 50:721

    Google Scholar 

  55. Marceau C, Parc Y, Debroux E, Tiret E, Parc R (2005) Complete rectal prolapse in young patients: psychiatric disease a risk factor of poor outcome. Colorectal Dis 7:360–365

    Article  PubMed  CAS  Google Scholar 

  56. Watts JD, Rotheberger DA, Buls JG et al (1985) The management of procidentia: 30 years’ experience. Dis Colon Rectum 28:96–102

    Article  PubMed  CAS  Google Scholar 

  57. Deen KI, Grant E, Billingham C, Keighley MRB (1994) Abdominal resection rectopexy with pelvic floor repair versus perineal rectosigmoidectomy and pelvic floor repair for full-thickness rectal prolapse. Br J Surg 81:302–304

    Article  PubMed  CAS  Google Scholar 

  58. Huber FT, Stein H, Siewert JR (1995) Functional results after treatment of rectal prolapsed with rectopexy and sigmoid resection. World J Surg 19:138–143

    Article  PubMed  CAS  Google Scholar 

  59. Kim D-S, Tsang CB, Wong WD et al (1999) Complete rectal prolapse: evolution of management and results. Dis Colon Rectum 42:460–469

    Article  PubMed  CAS  Google Scholar 

  60. Husa A, Sainio P, von Smitten K (1988) Abdominal rectopexy and sigmoid resection (Frykman-Goldberg operation) for rectal prolapse. Acta Chir Scand 154:221–224

    PubMed  CAS  Google Scholar 

  61. Stevenson AR, Stitz RW, Lumley JW (1998) Laparoscopic assisted resection rectopexy for rectal prolapse: early and medium follow-up. Dis Colon Rectum 41:46–54

    Article  PubMed  CAS  Google Scholar 

  62. Xynos E, Chrysos J, Tsiaoussis J et al (1999) Resection rectopexy for rectal prolapse: the laparoscopic approach. Surg Endosc 13:862–864

    Article  PubMed  CAS  Google Scholar 

  63. Rose J, Schneider C, Scheidbach H et al (2002) Laparoscopic treatment of rectal prolapse: experience gained in a prospective multicenter study. Lanenbecks Arch Surg 387:130–137

    Article  CAS  Google Scholar 

  64. Metcalf AM, Loening-Baucke V (1988) Anorectal function and defecation dynamics in patients with rectal prolapse. Am J Surg 155:206–210

    Article  PubMed  CAS  Google Scholar 

  65. Byrne CM, Smith SR, Solomon MJ, Young JM, Eyers AA, Young CJ (2008) Long-term functional outcomes after laparoscopic and open rectopexy for the treatment of rectal prolapsed. Dis Colon Rectum 51:1597–1604

    Article  PubMed  Google Scholar 

  66. Madiba TE, Baig MK, Wexner S (2005) Surgical management of rectal prolapse. Arch Surg 140:63–73

    Article  PubMed  Google Scholar 

  67. Tou S, Brown SR, Malik AI, Nelson RL (2008) Surgery for complete rectal prolapse in adults. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD001758

  68. Sajid MS, Siddiqui MR, Baig MK (2010) Open vs laparoscopic repair of full-thickness rectal prolapse: a re-meta-analysis. Colorectal Dis 12:515–525

    Google Scholar 

  69. Purkayastha S, Tekkis P, Athanasiou T et al (2005) A comparison of open versus laparoscopic abdominal rectopexy for full-thickness rectal prolapse: a meta-analysis. Dis Colon Rectum 48:1930–1940

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that no conflict of interest exists.

Author information

Authors and Affiliations

  1. Department of Surgery, University Hospital Tor Vergata, Viale Oxford 81, 00133, Rome, Italy

    F. Cadeddu, P. Sileri, M. Grande, E. De Luca, L. Franceschilli & G. Milito

Authors
  1. F. Cadeddu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Sileri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Grande
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. De Luca
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. L. Franceschilli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Milito
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Milito.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cadeddu, F., Sileri, P., Grande, M. et al. Focus on abdominal rectopexy for full-thickness rectal prolapse: meta-analysis of literature. Tech Coloproctol 16, 37–53 (2012). https://doi.org/10.1007/s10151-011-0798-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-011-0798-x

Keywords

Search

Navigation