title: It's the procedure not the patient: the operative approach is independently associated with an increased risk of complications after rectal prolapse repair.
abstract: OBJECTIVE
  This study compares 30-day outcomes following rectal prolapse repair, examining potential surgical and patient factors associated with perioperative complications.
  
  
  METHODS
  Using the NSQIP database, patients with rectal prolapse were categorized by surgical approach to repair (perineal or abdominal) and abdominal cases were further subdivided by procedure (resection compared with rectopexy alone). Univariate and multivariate analyses compared major and minor complication rates between the groups.
  
  
  RESULTS
  Of 1275 patients, the perineal group (n=706, 55%) was older, with more comorbidity, than those undergoing an abdominal procedure. There were fewer minor (odd ratio (OR)=0.35; 95% confidence interval (CI), 0.20-0.60; P=0.0038) and major complications (OR=0.46; 95% CI, 0.31-0.80; P=0.0038) in the perineal compared with the abdominal cohort. There was a significant increase in major complications amongst patients undergoing a resection compared with rectopexy only (OR=2.15; 95% CI, 1.10-4.41; P=0.0299). There was no difference in major complications between abdominal rectopexy and a perineal approach, but the latter had a lower chance of minor complications (OR=0.47; 95% CI, 0.24-0.94; P=0.0287).
  
  
  CONCLUSIONS
  A perineal approach is safer than an abdominal approach to the treatment of rectal prolapse. Regarding an abdominal operation, rectopexy has fewer major complications than resection.
authors.affiliation: Division of Colorectal Surgery, University of Rochester Medical Center, Rochester, New York 14642, USA. fergal_fleming@URMC.rochester.edu
authors.forename: F J
authors.initials: FJ
authors.lastname: Fleming
authors.forename: M J
authors.initials: MJ
authors.lastname: Kim
authors.forename: D
authors.initials: D
authors.lastname: Gunzler
authors.forename: S
authors.initials: S
authors.lastname: Messing
authors.forename: J R T
authors.initials: JR
authors.lastname: Monson
authors.forename: J R
authors.initials: JR
authors.lastname: Speranza
mesh_terms: D000005:Abdomen / Q000601:surgery; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010502:Perineum / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012005:Rectal Prolapse / Q000401:mortality / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome