Suture rectopexy versus ventral mesh rectopexy for complete full-thickness rectal prolapse and intussusception: systematic review and meta-analysis

Abstract

Background

This systematic review and meta-analysis aimed to compare recurrence rates of rectal prolapse following ventral mesh rectopexy (VMR) and suture rectopexy (SR).

Methods

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.

Results

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).

Conclusion

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.

Abstract

There have been long-term complications associated with synthetic mesh for ventral mesh rectopexy. This double-armed systematic review and meta-analysis aimed to compare recurrence rates of rectal prolapse following ventral mesh rectopexy and suture rectopexy. Limitations include a lack of comparative evidence owing to comparison of historical and current interventions and inconsistent follow-up; however, patient characteristics were consistent. The recurrence rates and safety of suture rectopexy are comparable to those of ventral mesh rectopexy and it could provide a safe alternative. An RCT comparing suture rectopexy and biological ventral mesh rectopexy is required.

Ventral mesh and suture rectopexy in rectal prolapse

Resumen

Antecedentes

Esta revisión sistemática con metaanálisis tuvo como objetivo comparar la tasa de recidiva del prolapso rectal tras de la rectopexia ventral con malla ( ventral mesh rectopexy, VMR) o con sutura ( suture rectopexy, SR).

Métodos

Se realizó una búsqueda de los estudios que notificaran la tasa de recidiva del prolapso rectal completo ( complete rectal prolapse, CPR) o de la invaginación ( intussusception, IS) tras SR o VMR en las bases MEDLINE, EMBASE y la Biblioteca Cochrane. Se agruparon los resultados y se compararon por procedimientos; se realizó un análisis de subgrupos comparando los pacientes con CPR e IS en los que se realizó una VMR con malla biológica o sintética. Se efectuó un metaanálisis de los estudios que comparaban SR y VMR. Para evaluar la calidad de los estudios se utilizaron la puntuación del Methodological Items for Non-Randomised Studies (MINORS), la escala Newcastle Ottawa y el instrumento de la Colaboración Cochrane.

Resultados

Se incluyeron 22 estudios con 976 pacientes en el grupo SR y 31 estudios con 1.605 pacientes en el grupo VMR. Se incluyeron 5 estudios en el metaanálisis. En general, en los pacientes con CRP, la tasa de recidiva fue del 8,6% tras RS y del 3,7% tras VMR ( P < 0,05). Sin embargo, en pacientes con IS tratados con VMR, la tasa de recidiva fue del 9,7%. No hubo diferencias en la tasa de recidiva después de VMR utilizando mallas biológicas o sintéticas, tanto en pacientes con CRP (4,1% versus 3,6%, P = 0,789) como con IS (11,4% versus 11,0%, P = 0,902). Los resultados del metaanálisis mostraron una heterogeneidad elevada; además, la diferencia en la tasa de recidiva entre los grupos SR y VMR no fue estadísticamente significativa ( P = 0,76)

Conclusión

Aunque la revisión sistemática puso de manifiesto un mayor número de recidivas en pacientes con CRP tratados con RS que con VMR, este resultado no se confirmó en el metaanálisis. Por lo tanto, se requieren ensayos controlados aleatorizados robustos que comparen la SR y la VMR con mallas biológicas.