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Recurrence Rates After Abdominal Surgery for Complete Rectal Prolapse: A Multicenter Pooled Analysis of 643 Individual Patient Data

Raftopoulos, Yannis M.D.; Senagore, Anthony J. M.D.; Di Giuro, Giuseppe M.D.; Bergamaschi, Roberto M.D., Ph.D.; For the Rectal Prolapse Recurrence Study Group (see Appendix)
Diseases of the Colon & Rectum: June 2005
doi: 10.1007/s10350-004-0948-6
Recurrence Rates After Abdominal Surgery for Complete Rectal Prolapse: A Multicenter Pooled Analysis of 643 Individual Patient Data: PDF Only

PURPOSE: PURPOSE:This study was designed to determine what impact surgical technique, means of access, and method of rectopexy have on recurrence rates following abdominal surgery for full-thickness rectal prolapse.

METHODS: METHODS:Consecutive individual patient data on age, gender, surgical technique (mobilization-only, mobilization-resection-pexy, or mobilization-pexy), means of access (open or laparoscopic), rectopexy method (suture or mesh), follow-up length, and recurrences were collected from 15 centers performing abdominal surgery for full-thickness rectal prolapse between 1979 and 2001. Recurrence was defined as the presence of full-thickness rectal prolapse after abdominal surgery. Chi-squared test and Cox proportional hazards regression analysis were used to assess statistical heterogeneity. Recurrence-free curves were generated and compared using the Kaplan-Meier method and log-rank test, respectively.

RESULTS: RESULTS:Abdominal surgery consisted of mobilization-only (n = 46), mobilization-resection-pexy (n = 130), or mobilization-pexy (n = 467). There were 643 patients. After excluding center 8, there was homogeneity on recurrence rates among the centers with recurrences (n = 8) for age (hazards ratio, 0.6; 95 percent confidence interval, 0.2-1.7;P= 0.405), gender (hazards ratio, 0.6; 95 percent confidence interval, 0.1-2.3;P= 0.519), and center (hazards ratio, 0.3; 95 percent confidence interval, 0.1-1.5;P= 0.142). However, there was heterogeneity between centers with (n = 8) and without recurrences (n = 6) for gender (P= 0.0003), surgical technique (P< 0.0001), means of access (P= 0.01), and rectopexy method (P< 0.0001). The median length of follow-up of individual centers varied from 4 to 127 months (P< 0.0001). There were 38 recurrences at a median follow-up of 43 (range, 1-235) months. The pooled one-, five-, and ten-year recurrence rates were 1.06, 6.61, and 28.9 percent, respectively. Age, gender, surgical technique, means of access, and rectopexy method had no impact on recurrence rates.

CONCLUSIONS: CONCLUSIONS:Although this study is likely underpowered, the impact of mobilization-only on recurrence rates was similar to that of other surgical techniques.

Presented at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004

aAllegheny General Hospital, 320 East North Avenue, Pittsburgh, Pennsylvania, 15212

© The ASCRS 2005