title: Recurrence of rectal prolapse following rectopexy: a pooled analysis of 532 patients.
abstract: OBJECTIVE
  The study was designed to address the unanswered question of the influence of the extent of rectal mobilization, the type of rectal fixation and the surgical access (open vs laparoscopic) on recurrence rates following abdominal surgery for full-thickness rectal prolapse (FTRP).
  
  
  METHODS
  Individual patient data were pooled and data merging was performed following comparison of variable definitions to ensure similarity in definitions. Recurrence after rectopexy was defined as the presence of FTRP on physical examination. The impact of categorical factors on recurrence was assessed using Fisher's exact and the chi-squared tests. Recurrence-free survival curves were generated for patients and differences in time to recurrence were compared using the log rank test. Factors passing univariate screening with a P value < 0.1 were included in a multivariate model.
  
  
  RESULTS
  After data matching and merging, 532 patients were included. The duration of follow-up ranged from 12 to 235 months. There were 46 (8.6%) recurrences at a median follow-up of 60 months. Mean age was 53.6 ± 17 years, 359 (67.5%) were female, the mean length of external prolapse was 6.3 ± 4 cm, and previous abdominal surgery had taken place in 33.7%. Four variables were identified on initial univariate screening as being related to recurrence. They included a history of incontinence (P = 0.09), constipation (P = 0.018), the extent of rectal mobilization (P = 0.004) and the role of sigmoid resection (P = 0.057). Using multivariate analysis, only the degree of mobilization was independently associated with recurrence (P = 0.026).
  
  
  CONCLUSIONS
  Circumferential rectal mobilization during rectopexy was associated with a decreased long-term recurrence rate. The type of rectal fixation and the type of surgical access did not influence recurrence.
authors.affiliation: Division of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA.
authors.forename: M
authors.initials: M
authors.lastname: Bishawi
authors.affiliation: Division of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA.
authors.forename: C
authors.initials: C
authors.lastname: Foppa
authors.affiliation: Division of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA.
authors.forename: S
authors.initials: S
authors.lastname: Tou
authors.affiliation: Division of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA.
authors.forename: R
authors.identifier: http://orcid.org/0000-0001-9993-0563
authors.initials: R
authors.lastname: Bergamaschi
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D003248:Constipation / Q000209:etiology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D012005:Rectal Prolapse / Q000150:complications / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors
keywords: Rectal mobilization; full-thickness rectal prolapse (FTRP); laparoscopic surgery; open surgery; recurrence rates