A network meta-analysis of surgical treatments of complete rectal prolapse

Purpose: 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). Methods: 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. Results: 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. Conclusions: Posterior mesh rectopexy ranked best with the lowest recurrence while perineal procedures ranked worst with the highest recurrence rates.