Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA.
Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt.
Tech Coloproctol. 2023 Oct;27(10):787-797. doi: 10.1007/s10151-023-02813-2. Epub 2023 May 8.
Surgical treatment of complete rectal prolapse can be undertaken via an abdominal or a perineal approach. The present network meta-analysis aimed to compare the outcomes of different abdominal and perineal procedures for rectal prolapse in terms of recurrence, complications, and improvement in fecal incontinence (FI).
A PRISMA-compliant systematic review of PubMed, Scopus, and Web of Science was conducted. Randomized clinical trials comparing two or more procedures for the treatment of complete rectal prolapse were included. The risk of bias was assessed using the ROB-2 tool. The main outcomes were recurrence of full-thickness rectal prolapse, complications, operation time, and improvement in FI.
Nine randomized controlled trials with 728 patients were included. The follow-up ranged between 12 and 47 months. Posterior mesh rectopexy had significantly lower odds of recurrence than did the Altemeier procedure (logOR, - 12.75; 95% credible intervals, - 40.91, - 1.75), Delorme procedure (- 13.10; - 41.26, - 2.09), resection rectopexy (- 11.98; - 41.36, - 0.19), sponge rectopexy (- 13.19; - 42.87, - 0.54), and sutured rectopexy (- 13.12; - 42.58, - 1.50), but similar odds to ventral mesh rectopexy (- 12.09; - 41.7, 0.03). Differences among the procedures in complications, operation time, and improvement in FI were not significant.
Posterior mesh rectopexy ranked best with the lowest recurrence while perineal procedures ranked worst with the highest recurrence rates.
完全性直肠脱垂的手术治疗可通过腹部或会阴途径进行。本网络荟萃分析旨在比较不同腹部和会阴手术治疗直肠脱垂在复发、并发症和改善粪便失禁（FI）方面的结局。
对 PubMed、Scopus 和 Web of Science 进行了符合 PRISMA 标准的系统评价。纳入比较两种或两种以上手术治疗完全性直肠脱垂的随机临床试验。使用 ROB-2 工具评估偏倚风险。主要结局是全层直肠脱垂复发、并发症、手术时间和 FI 改善。
纳入了 9 项随机对照试验，共 728 名患者。随访时间为 12 至 47 个月。后兜带直肠固定术的复发率明显低于 Altemeier 手术（对数比值比，-12.75；95%可信区间，-40.91，-1.75）、Delorme 手术（-13.10；-41.26，-2.09）、直肠切除固定术（-11.98；-41.36，-0.19）、海绵直肠固定术（-13.19；-42.87，-0.54）和缝合直肠固定术（-13.12；-42.58，-1.50），但与腹侧网片直肠固定术的复发率相似（-12.09；-41.7，0.03）。各手术方法在并发症、手术时间和 FI 改善方面的差异无统计学意义。
后兜带直肠固定术复发率最低，会阴手术复发率最高。
