University of Liverpool, Liverpool, UK.
St Helen's and Knowsley Teaching Hospitals NHS Trust.
BJS Open. 2021 Jan 8;5(1). doi: 10.1093/bjsopen/zraa037.
This systematic review and meta-analysis aimed to compare recurrence rates of rectal prolapse following ventral mesh rectopexy (VMR) and suture rectopexy (SR).
MEDLINE, Embase, and the Cochrane Library were searched for studies reporting on the recurrence rates of complete rectal prolapse (CRP) or intussusception (IS) after SR and VMR. Results were pooled and procedures compared; a subgroup analysis was performed comparing patients with CRP and IS who underwent VMR using biological versus synthetic meshes. A meta-analysis of studies comparing SR and VMR was undertaken. The Methodological Items for Non-Randomized Studies score, the Newcastle-Ottawa Scale, and the Cochrane Collaboration tool were used to assess the quality of studies.
Twenty-two studies with 976 patients were included in the SR group and 31 studies with 1605 patients in the VMR group; among these studies, five were eligible for meta-analysis. Overall, in patients with CRP, the recurrence rate was 8.6 per cent after SR and 3.7 per cent after VMR (P < 0.001). However, in patients with IS treated using VMR, the recurrence rate was 9.7 per cent. Recurrence rates after VMR did not differ with use of biological or synthetic mesh in patients treated for CRP (4.1 versus 3.6 per cent; P = 0.789) and or IS (11.4 versus 11.0 per cent; P = 0.902). Results from the meta-analysis showed high heterogeneity, and the difference in recurrence rates between SR and VMR groups was not statistically significant (P = 0.76).
Although the systematic review showed a higher recurrence rate after SR than VMR for treatment of CRP, this result was not confirmed by meta-analysis. Therefore, robust RCTs comparing SR and biological VMR are required.
本系统评价和荟萃分析旨在比较腹侧网片直肠固定术（VMR）和缝合直肠固定术（SR）治疗直肠前突后的复发率。
检索 MEDLINE、Embase 和 Cochrane 图书馆，以获取关于 SR 和 VMR 治疗后完全直肠前突（CRP）或套叠（IS）复发率的研究报告。汇总结果并比较程序；对接受生物和合成网片的 VMR 治疗 CRP 和 IS 患者进行亚组分析。对比较 SR 和 VMR 的研究进行荟萃分析。使用非随机研究方法项目评分、纽卡斯尔-渥太华量表和 Cochrane 协作工具评估研究质量。
22 项研究纳入了 976 例 SR 组患者，31 项研究纳入了 1605 例 VMR 组患者；其中 5 项研究符合荟萃分析条件。总体而言，在 CRP 患者中，SR 后复发率为 8.6%，VMR 后为 3.7%（P<0.001）。然而，在接受 VMR 治疗的 IS 患者中，复发率为 9.7%。在治疗 CRP 患者时，VMR 后使用生物或合成网片的复发率无差异（4.1%比 3.6%；P=0.789），治疗 IS 患者时也无差异（11.4%比 11.0%；P=0.902）。荟萃分析结果显示存在高度异质性，SR 和 VMR 组之间的复发率差异无统计学意义（P=0.76）。
虽然系统评价显示 SR 治疗 CRP 的复发率高于 VMR，但荟萃分析并未证实这一结果。因此，需要进行比较 SR 和生物 VMR 的随机对照试验。
