Delorme's vs. Altemeier's in the management of rectal procidentia: systematic review and meta-analysis.
Altemeier’s
Delorme’s
Rectal prolapse
Rectosigmoidectomy
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
02 Dec 2023
02 Dec 2023
Historique:
received:
16
08
2023
accepted:
15
11
2023
medline:
4
12
2023
pubmed:
2
12
2023
entrez:
2
12
2023
Statut:
epublish
Résumé
Rectal prolapse is a distressing condition for patients and no consensus exists on optimal surgical management. We compared outcomes of two common perineal operations (Delorme's and Altemeier's) used in the treatment of rectal prolapse. A systematic search of multiple electronic databases was conducted. Peri- and post-operative outcomes following Delorme's and Altemeier's procedures were extracted. Primary outcomes included recurrence rate, anastomotic dehiscence rate and mortality rate. The secondary outcomes were total operative time, volume of blood loss, length of hospital stay and coloanal anastomotic stricture formation. Revman 5.3 was used to perform all statistical analysis. Ten studies with 605 patients were selected; 286 underwent Altemeier's procedure (standalone), 39 had Altemeier's with plasty (perineoplasty or levatoroplasty), and 280 had Delorme's. Recurrence rate [OR: 0.66; 95% CI [0.44-0.99], P = 0.05] was significantly lower and anastomotic dehiscence [RD: 0.05; 95% CI [0.00-0.09], P = 0.03] was significantly higher in the Altemeier's group. However, sub group analysis of Altemeier's with plasty failed to show significant differences in these outcomes compared with the Delorme's procedure. Length of hospital stay was significantly more following an Altemeier's operation compared with Delorme's [MD: 3.05, 95% CI [0.95 - 5.51], P = 0.004]. No significant difference was found in total operative time, intra-operative blood loss, coloanal anastomotic stricture formation and mortality rates between the two approaches. A direct comparison of two common perineal procedures used in the treatment of rectal prolapse demonstrated that the Altemeier's approach was associated with better outcomes. Future, well-designed high quality RCTs with long-term follow up are needed to corroborate our findings.
Sections du résumé
BACKGROUND
BACKGROUND
Rectal prolapse is a distressing condition for patients and no consensus exists on optimal surgical management. We compared outcomes of two common perineal operations (Delorme's and Altemeier's) used in the treatment of rectal prolapse.
METHODS
METHODS
A systematic search of multiple electronic databases was conducted. Peri- and post-operative outcomes following Delorme's and Altemeier's procedures were extracted. Primary outcomes included recurrence rate, anastomotic dehiscence rate and mortality rate. The secondary outcomes were total operative time, volume of blood loss, length of hospital stay and coloanal anastomotic stricture formation. Revman 5.3 was used to perform all statistical analysis.
RESULTS
RESULTS
Ten studies with 605 patients were selected; 286 underwent Altemeier's procedure (standalone), 39 had Altemeier's with plasty (perineoplasty or levatoroplasty), and 280 had Delorme's. Recurrence rate [OR: 0.66; 95% CI [0.44-0.99], P = 0.05] was significantly lower and anastomotic dehiscence [RD: 0.05; 95% CI [0.00-0.09], P = 0.03] was significantly higher in the Altemeier's group. However, sub group analysis of Altemeier's with plasty failed to show significant differences in these outcomes compared with the Delorme's procedure. Length of hospital stay was significantly more following an Altemeier's operation compared with Delorme's [MD: 3.05, 95% CI [0.95 - 5.51], P = 0.004]. No significant difference was found in total operative time, intra-operative blood loss, coloanal anastomotic stricture formation and mortality rates between the two approaches.
CONCLUSIONS
CONCLUSIONS
A direct comparison of two common perineal procedures used in the treatment of rectal prolapse demonstrated that the Altemeier's approach was associated with better outcomes. Future, well-designed high quality RCTs with long-term follow up are needed to corroborate our findings.
Identifiants
pubmed: 38041773
doi: 10.1007/s00423-023-03181-z
pii: 10.1007/s00423-023-03181-z
doi:
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
454Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Goldstein SD, Maxwell PJ 4th (2011) Rectal prolapse. Clin Colon Rectal Surg 24(1):39–45. https://doi.org/10.1055/s-0031-1272822
doi: 10.1055/s-0031-1272822
pubmed: 22379404
pmcid: 3140332
Vernava AM, Beck DE (2007) Rectal prolapse. In: Wolff, B.G., et al. The ASCRS textbook of colon and rectal surgery. Springer, New York, NY. https://doi.org/10.1007/978-0-387-36374-5_47
Hammond K, Beck DE, Margolin DA, Whitlow CB, Timmcke AE, Hicks TC (2007) Rectal prolapse: a 10-year experience. Ochsner J 7(1):24–32 (Spring)
pubmed: 21603476
pmcid: 3096348
Sun C, Hull T, Ozuner G (2014) Risk factors and clinical characteristics of rectal prolapse in young patients. J Visc Surg 151(6):425–429. https://doi.org/10.1016/j.jviscsurg.2014.07.013
doi: 10.1016/j.jviscsurg.2014.07.013
pubmed: 25242503
Rectal Prolapse. https://patient.info/doctor/rectal-prolapse . Accessed 22/06/2023
Kraiem I, Kellil T, Chaouch MA, Korbi I, Zouari K (2020) Strangled rectal prolapse in young adults: A case report. Ann Med Surg (Lond) 11(55):33–35. https://doi.org/10.1016/j.amsu.2020.04.030
doi: 10.1016/j.amsu.2020.04.030
Fazeli MS, Kazemeini AR, Keshvari A, Keramati MR (2013) Delorme’s procedure: An effective treatment for a full-thickness rectal prolapse in young patients. Ann Coloproctol 29(2):60–5. https://doi.org/10.3393/ac.2013.29.2.60
doi: 10.3393/ac.2013.29.2.60
pubmed: 23700572
pmcid: 3659244
Altemeier WA, Culbertson WR, Schowengerdt C, Hunt J (1971) Nineteen years’ experience with the one-stage perineal repair of rectal prolapse. Ann Surg 173(6):993–1006. https://doi.org/10.1097/00000658-197106010-00018
doi: 10.1097/00000658-197106010-00018
pubmed: 5578808
pmcid: 1397506
Rao SS, Go JT (2009) Treating pelvic floor disorders of defecation: management or cure? Curr Gastroenterol Rep 11(4):278–287. https://doi.org/10.1007/s11894-009-0041-3
doi: 10.1007/s11894-009-0041-3
pubmed: 19615303
pmcid: 3883497
Barfield LR (2017) Perineal approaches to rectal prolapse. Clin Colon Rectal Surg 30(1):12–15. https://doi.org/10.1055/s-0036-1593432
doi: 10.1055/s-0036-1593432
pubmed: 28144207
pmcid: 5179277
Higgins JPT, Green S (eds) (2011) Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0 [updated March 2011]. http://www.cochrane.org/handbook (Accessed 22 June 2015)
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8:336–341
doi: 10.1016/j.ijsu.2010.02.007
pubmed: 20171303
Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, Tugwell P (2015) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp (Accessed Dec 2021)
Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 18:343
GRADEpro GDT: GRADEpro Guideline Development Tool [Software]. McMaster University and Evidence Prime, 2022. Available from http://gradepro.org
Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMCMed Res Methodol 5:13
doi: 10.1186/1471-2288-5-13
Smedberg J, Graf W, Pekkari K, Hjern F (22) Comparison of four surgical approaches for rectal prolapse: multicentre randomized clinical trial. BJS Open 6(1):zrab140
Xu YJ, Zhang D, Zhang H, Sun YZ, Liu C, Ren DL (2019) Efficacy analysis of Altemeier and Delorme procedures for the rectal prolapse. Zhonghua Wei Chang Wai Ke Za Zhi 22(12):1170–1176. https://doi.org/10.3760/cma.j.issn.1671-0274.2019.12.013 . (Chinese)
doi: 10.3760/cma.j.issn.1671-0274.2019.12.013
pubmed: 31874534
Gleditsch D, Wexels WA, Nesbakken A (2018) Surgical options and trends in treating rectal prolapse: long-term results in a 19-year follow-up study. Langenbecks Arch Surg 403(8):991–998. https://doi.org/10.1007/s00423-018-1728-4
doi: 10.1007/s00423-018-1728-4
pubmed: 30415286
Elagili F, Gurland B, Liu X, Church J, Ozuner G (2015) Comparing perineal repairs for rectal prolapse: Delorme versus Altemeier. Tech Coloproctol 19(9):521–525. https://doi.org/10.1007/s10151-015-1337-y
doi: 10.1007/s10151-015-1337-y
pubmed: 26341686
Mik M, Trzcinski R, Kujawski R, Dziki L, Tchorzewski M, Dziki A (2015) Rectal prolapse in women-outcomes of perineal and abdominal approaches. Indian J Surg 77(Suppl 3):1121–5. https://doi.org/10.1007/s12262-014-1196-1
doi: 10.1007/s12262-014-1196-1
pubmed: 27011522
Senapati A, Gray RG, Middleton LJ et al (2013) PROSPER: a randomised comparison of surgical treatments for rectal prolapse. Colorectal Dis 15(7):858–868. https://doi.org/10.1111/codi.12177
doi: 10.1111/codi.12177
pubmed: 23461778
Boccasanta P, Rosati R, Venturi M, Cioffi U, De Simone M, Montorsi M, Peracchia A (1999) Surgical treatment of complete rectal prolapse: results of abdominal and perineal approaches. J Laparoendosc Adv Surg Tech A 9(3):235–238. https://doi.org/10.1089/lap.1999.9.235
doi: 10.1089/lap.1999.9.235
pubmed: 10414538
Whitlow CB, Beck DE, Opelka FG, Gathright JB Jr, Timmcke AE, Hicks T (1997) Perineal repair of rectal prolapse. J La State Med Soc 149(1):22–26
pubmed: 9033191
Agachan F, Reissman P, Pfeifer J, Weiss EG, Nogueras JJ, Wexner SD (1997) Comparison of three perineal procedures for the treatment of rectal prolapse. South Med J 90(9):925–932. https://doi.org/10.1097/00007611-199709000-00013
doi: 10.1097/00007611-199709000-00013
pubmed: 9305305
Lehtola A, Salo JA, Fräki O, Lempinen M (1987) Treatment of rectal prolapse. A clinical study of 50 consecutive patients. Ann Chir Gynaecol 76(3):150–4
pubmed: 3674723
Mustain WC, Davenport DL, Parcells JP, Vargas HD, Hourigan JS (2013) Abdominal versus perineal approach for treatment of rectal prolapse: comparable safety in a propensity-matched cohort. Am Surg 79(7):686–692
doi: 10.1177/000313481307900712
pubmed: 23816001
Bordeianou L, Paquette I, Johnson E, Holubar SD, Gaertner W, Feingold DL, Steele SR (2017) Clinical practice guidelines for the treatment of rectal prolapse. Dis Colon Rectum 60(11):1121–1131. https://doi.org/10.1097/DCR.0000000000000889
doi: 10.1097/DCR.0000000000000889
pubmed: 28991074
Emile SH, Elbanna H, Youssef M, Thabet W, Omar W, Elshobaky A, Abd El-Hamed TM, Farid M (2017) Laparoscopic ventral mesh rectopexy vs Delorme’s operation in management of complete rectal prolapse: a prospective randomized study. Colorectal Dis 19(1):50–57. https://doi.org/10.1111/codi.13399
doi: 10.1111/codi.13399
pubmed: 27225971
Tou S, Brown SR, Nelson RL (2015) Surgery for complete (full-thickness) rectal prolapse in adults. Cochrane Database Syst Rev 2015(11):CD001758. https://doi.org/10.1002/14651858.CD001758.pub3
Ram E, Hoffman A, Goldes Y, Rosin D, Horesh N, Gutman M, Edden Y (2018) Perineal Stapled Rectal Prolapse Resection in Elderly Patients: Long-term Follow-up. Dis Colon Rectum 61(11):1316–1319. https://doi.org/10.1097/DCR.0000000000001215
doi: 10.1097/DCR.0000000000001215
pubmed: 30239390
van der Schans EM, Paulides TJC, Wijffels NA, Consten ECJ (2018) Management of patients with rectal prolapse: the 2017 Dutch guidelines. Tech Coloproctol 22(8):589–596. https://doi.org/10.1007/s10151-018-1830-1
doi: 10.1007/s10151-018-1830-1
pubmed: 30099626
Houry S, Lechaux JP, Huguier M, Molkhou JM (1987) Treatment of rectal prolapse by Delorme’s operation. Int J Colorectal Dis 2(3):149–52. https://doi.org/10.1007/BF01647997
doi: 10.1007/BF01647997
pubmed: 3309100
Oruc M, Erol T (2023) Current diagnostic tools and treatment modalities for rectal prolapse. World J Clin Cases 11(16):3680–3693
doi: 10.12998/wjcc.v11.i16.3680
pubmed: 37383136
pmcid: 10294152
Emile SH, Elfeki H, Shalaby M, Sakr A, Sileri P, Wexner SD (2017) Perineal resectional procedures for the treatment of complete rectal prolapse: A systematic review of the literature. Int J Surg 46:146–154. https://doi.org/10.1016/j.ijsu.2017.09.005
doi: 10.1016/j.ijsu.2017.09.005
pubmed: 28890414
Waniczek D, Copija A, Janiszewska J, Maruszczak P, Raźnikiewicz A, Arendt J (2012) Mikulicz’s procedure with levator muscle and external anal sphincter plasty in the treatment of rectal prolapse. Pol Przegl Chir 84(12):626–31. https://doi.org/10.2478/v10035-012-0103-3
doi: 10.2478/v10035-012-0103-3
pubmed: 23399629
Ris F, Colin JF, Chilcott M, Remue C, Jamart J, Kartheuser A (2012) Altemeier’s procedure for rectal prolapse: analysis of long-term outcome in 60 patients. Colorectal Dis 14(9):1106–1111
doi: 10.1111/j.1463-1318.2011.02904.x
pubmed: 22150996
Kumar N, Kumar D (2019) Fecal incontinence and rectal prolapse. Indian J Gastroenterol 38(6):465–469. https://doi.org/10.1007/s12664-020-01014-1
doi: 10.1007/s12664-020-01014-1
pubmed: 32002830
Pescatori M, Gagliardi G (2008) Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Tech Coloproctol 12(1):7–19. https://doi.org/10.1007/s10151-008-0391-0
doi: 10.1007/s10151-008-0391-0
pubmed: 18512007
pmcid: 2778725
Youssef M, Thabet W, El Nakeeb A, Magdy A, Alla EA, El Nabeey MA et al (2013) Comparative study between Delorme operation with or without postanal repair and levateroplasty in treatment of complete rectal prolapse. Int J Surg 11(1):52
doi: 10.1016/j.ijsu.2012.11.011
pubmed: 23187047
Gachabayov M, Bendl R, Flusberg M, Grimes CL, Altomare DF, Ozuner G et al (2021) Rectal prolapse and pelvic descent. Curr Probl Surg 58(9):100952
doi: 10.1016/j.cpsurg.2020.100952
pubmed: 34489052
Kim M, Reibetanz J, Schlegel N, Krajinovic K, Köstler H, Germer CT et al (2014) Recurrence after perineal rectosigmoidectomy: When and why? Colorectal Dis 16(11):920
doi: 10.1111/codi.12756
pubmed: 25156102
Sakr A, Emile SH, Abdallah E, Thabet W, Khafagy W (2017) Predictive factors for small intestinal and colonic anastomotic leak: a multivariate analysis. Indian J Surg 79(6):555
doi: 10.1007/s12262-016-1556-0
pubmed: 29217909
Pinheiro LV, Leal RF, Coy CS, Fagundes JJ, Martinez CA, Ayrizono Mde L (2016) Long-term outcome of perineal rectosigmoidectomy for rectal prolapse. Int J Surg 32:78–82. https://doi.org/10.1016/j.ijsu.2016.06.040
doi: 10.1016/j.ijsu.2016.06.040
pubmed: 27345263
Cirocco WC (2010) The Altemeier procedure for rectal prolapse: An operation for all ages. Dis Colon Rectum 53(12):1618
doi: 10.1007/DCR.0b013e3181f22cef
pubmed: 21178855
Kimmins MH, Evetts BK, Isler J, Billingham R (2001) The Altemeier repair: Outpatient treatment of rectal prolapse. Dis Colon Rectum 44(4):565
doi: 10.1007/BF02234330
pubmed: 11330584
Pellino G, Fuschillo G, Simillis C, Selvaggi L, Signoriello G, Vinci D, Kontovounisios C, Selvaggi F, Sciaudone G (2021) Abdominal versus perineal approach for external rectal prolapse: systematic review with meta-analysis. BJS Open 6(2):zrac018. https://doi.org/10.1093/bjsopen/zrac018