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Anna R. Spivak*, Marianna Maspero, Rebecca Y. Spivak, Jessica A. Sankovic, Stephanie Norman, Caitlyn Deckard, Scott Steele, Tracy L. Hull
Cleveland Clinic, Cleveland, OH

Background: Resection rectopexy (RR) and ventral mesh rectopexy (VMR) are widely accepted surgical options for the treatment of rectal prolapse, however reports on long-term recurrence rates and functional outcomes are lacking. The aim of our study was to investigate differences in recurrence rates and functional outcomes a decade after RR vs VMR. We hypothesized that VMR would have a lower recurrence rate and superior functional outcomes versus RR.
Methods: We retrospectively reviewed our prospectively collected database on surgery for rectal prolapse. Patients who underwent RR or VMR at our center between 2009 and 2016 were included. All patients were contacted by phone and administered three validated questionnaires: Global Quality of Life (GQoL) scale, Patient Global Impression of Change (PGIC), and Initial Measurement of Patient-reported Pelvic Floor Complaints Tool Short Form (IMPACT-SF). Data on prolapse recurrence was also collected. We compared quality of life, long-term functional outcomes and prolapse recurrence.
Results: 220 patients were included, of which 208 (94%) female; 85 (39%) underwent RR, 135 (61%) VMR. The RR group was younger (median 52 vs 60 years old, p = 0.02) and had more open procedures (20% vs 9%, p < 0.001) (Table 1). The VMR group had more combined procedures (58% vs 23%, p < 0.001). After a median follow up of 110 (IQR 94 – 146) months for RR and 113 (87 – 137) for VMR, recurrences occurred in 21 (26%) in the RR and 50 (39%) in the VMR group. The recurrence rate at 5- and 10-years was 16% and 34% for RR, and 28% and 44% for VMR (p = 0.047) (Figure 1). Median time to recurrence was 44 (18 – 80) months in the RR group and 28.5 (11 – 52.5) in the VMR group (p = 0.14). Recurrence was managed conservatively in 52% cases in the RR and 54% in the VMR group (p = 0.79). At follow up, 69 (81%) in the RR and 113 (84%) in the VMR group were still alive: of those, 36 (52%) for the RR and 67 (59%) for the VMR group consented to participate to the phone interview. GQoL, PGIC, functional outcomes, and solid and fecal incontinences rates were similar between the two groups.
Conclusion: Long-term quality of life and functional outcomes after RR and VMR were comparable. Contrary to our hypothesis, VMR was associated with a higher prolapse recurrence rate.

Figure 1. Kaplan Meier curve of prolapse recurrence after resection rectopexy versus ventral rectopexy

Table 1. Characteristics of the two groups and long term functional outcomes

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