Laparoscopic Management of Recurrent Complete Rectal Prolapse: A Meta-Analysis Study

Abstract Background: Complete rectal prolapse is a disabling condition that presents with fecal incontinence, constipation and rectal discharge. Described surgical techniques are varied, and whether the approach is abdominal or perineal, the treat-ment aims to correct anatomical and functional abnormalities by the fixation of the rectum to the sacrum and/or the resection of the redundant bowel. Recently, an abdominal approach via laparoscopy has emerged as a tool for the treatment of rectal prolapse that is a safe and effective alternative to the conven-tional open approach. Laparoscopic rectopexy results in lesser postoperative pain, lesser hospital stay, and better patient satisfaction than open rectopexy. Aim of Study: A meta-analysis Study of laparoscopic management of recurrent complete rectal prolapse, through a process of combining the results of individual studies with statistical methods in one review, regarding laparoscopic operations performed most frequently (Resection rectopexy, Suture rectopexy, Mesh rectopexy) and to examine the outcome following recurrence surgery. Material and Methods: We identified 21 studies with a total population of 869 patients comparing different types laparoscopic rectopexy (suture, Resection, and Mesh either posterior or ventral). Results: A significant positive result regarding the post-operative morbidity after laparoscopic stature rectopexy and laparoscopic resection rectopexy were found, meaning that there are some risks of morbidity after LSR and LRR, while there were no risks of morbidity after neither posterior nor ventral LMR. According to the present study there was a significant improvement of constipation after LSR, posterior LMR and LRR, with significant p-values of <0.0001. However, there was no significant improvement of continence after LSR. The analysis of the included studies in this meta-analysis showed a significant positive result regarding the improvement of continence postoperatively after laparoscopic resection rectopexy, posterior and ventral laparoscopic mesh rectopexy, meaning that there was a significant improvement of continence after LRR, posterior and ventral LMR. Data Sources: Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021.
Conclusion: No risk of recurrence was detected in any of the laparoscopic approaches. Although, laparoscopic suture rectopexy (LSR) showed improvement of constipation, it had several adverse events (risk of morbidity, no improvement of continence and new onset of constipation). Laparoscopic resection rectopexy (LRR) showed improvement of the pre-operative constipation and continence but it cause significant postoperative morbidity and new onset of constipation. Pos-terior LMR caused improvement of the preoperative consti-pation and continence, with no postoperative morbidity. Unfortunately, it caused new onset of constipation. Ventral LMR showed improvement of the preoperative continence with no postoperative morbidity or new onset of constipation.