Details

Autor(en) / Beteiligte

• Sharma, Sahil
• Mckechnie, Tyler
• Khamar, Jigish
• Ichhpuniani, Simarpreet
• Eskicioglu, Cagla

Titel

Recurrence following perineal rectosigmoidectomy ( Altemeier) with levatorplasty: a systematic review and meta-analysis

Ist Teil von

• Canadian Journal of Surgery, 2022-11, Vol.65, p.S69-S69

Ort / Verlag

Ottawa: CMA Impact, Inc

Erscheinungsjahr

2022

Quelle

EZB-FREE-00999 freely available EZB journals

Beschreibungen/Notizen

• Background: Full-thickness rectal prolapse is associated with significant morbidity and remains a challenging pathology to correct surgically with significant recurrence rates. Among perineal surgical approaches, the perineal rectosigmoidectomy, commonly referred to as the Altemeier procedure, is the most frequently performed. The addition of levatorplasty has been postulated to improve recurrence rates; however, its efficacy varies across prospective studies. The aim of this study was to systematically review recurrence rates following Altemeier with levatorplasty, and to meta-analyze pooled data comparing recurrence rates between Altemeier with and without a levatorplasty. Methods: A search of Embase, Ovid MEDLINE, and CENTRAL was performed from database inception to October 2021 aimed at identifying all studies investigating recurrence rate of rectal prolapse following Alteimer with levatorplasty. The primary end point was recurrence of rectal prolapse. Articles that did not report the primary end point or did not evaluate Altemeir procedure with levatorplasty were excluded. A pairwise meta-analysis was performed using Mantel-Haenszel random effects. Results: From 200 citations, a total of 14 primary studies met inclusion criteria. A total of 620 patients (88.9% female, mean age 71 yr) underwent Altemeier with levatorplasty. Of the patients undergoing levatorplasty, 86 (13.8%) experienced a recurrence. Mean follow-up was 46 months. Meta-analysis of recurrence rates between Altemeier with and without levatorplasty demonstrated no significant difference (relative risk 0.92, 95% confidence interval 0.32-2.59, p = 0.87, I2 = 77%). Conclusion: Narrative review of postoperative quality of life metrics demonstrated an improvement in incontinence following Altemeier with levatorplasty as measured by the Wexner and ICIQ-SIF scores. The addition of a levatorplasty does not significantly reduce the risk of recurrent rectal prolapse after an Altemeier; however, it may improve incontinence. Additional randomized controlled trials with standardized surgical techniques are needed to confirm the findings of this review.