Outcomes of Laparoscopic Suture Rectopexy Versus Laparoscopic Mesh Rectopexy: A Systematic Review and Meta-Analysis

Abstract

The contemporary literature provides conflicting evidence regarding the precedence of laparoscopic mesh rectopexy over laparoscopic suture rectopexy for full-thickness rectal prolapse. This study aimed to compare the clinical outcomes of mesh and suture rectopexy to improve the surgical management of complete rectal prolapse. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to extract studies based on mesh versus suture rectopexy and published from 2001 to 2023. The articles of interest were obtained from PubMed Central, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Journal Storage (JSTOR), Web of Science, Embase, Scopus, and the Cochrane Library. The primary outcomes included rectal prolapse recurrence, constipation improvement, and operative time. The secondary endpoints included the Cleveland Clinic Constipation Score, Cleveland Clinic Incontinence Score, intraoperative bleeding, hospital stay duration, mortality, overall postoperative complications, and surgical site infection. A statistically significant low recurrence of rectal prolapse (odds ratio: 0.41, 95% confidence interval (CI) 0.21-0.80; p=0.009) and longer mean operative duration (mean difference: 27.05, 95% CI 18.86-35.24; p<0.00001) were observed in patients with mesh rectopexy versus suture rectopexy. Both study groups, however, had no significant differences in constipation improvement and all secondary endpoints (all p>0.05). The laparoscopic mesh rectopexy was associated with a low postoperative rectal prolapse recurrence and a longer operative duration compared to laparoscopic suture rectopexy. Prospective randomized controlled trials should further evaluate mesh and suture rectopexy approaches for postoperative outcomes to inform the surgical management of complete rectal prolapse.

Keywords: clinical outcomes; complete rectal prolapse; full-thickness rectal prolapse; laparoscopic rectopexy; mesh rectopexy; postoperative; suture rectopexy.

Figure 1. Study flow diagram

Figure 2. Rectal prolapse recurrence

Studies by Gleditsch et al. [31], Hidaka et al. [32], Luglio et al. [34], Lundby et al. [35], Mohammedy et al. [36], Raftopoulos et al. [37], Sahoo et al. [38], Usman et al. [39], and Yehya et al. [40]

Figure 3. Constipation improvement

Studies by Sahoo et al. [38], Usman et al. [39], Yehya et al. [40], and Bhandarwar et al. [41]

Figure 4. Operative time (minutes)

Studies by Benoist et al. [33], Lundby et al. [35], Mohammedy et al. [36], Sahoo et al. [38], Usman et al. [39], Yehya et al. [40], and Bhandarwar et al. [41]

Figure 5. CCCS

Studies by Hidaka et al. [32], Luglio et al. [34], Lundby et al. [35], and Mohammedy et al. [36] CCCS: Cleveland Clinic Constipation Score

Figure 6. CCIS

Studies by Hidaka et al. [32], Luglio et al. [34], Lundby et al. [35], and Mohammedy et al. [36] CCIS: Cleveland Clinic Incontinence Score

Figure 7. Intraoperative bleeding

Studies by Lundby et al. [35] and Usman et al. [39]

Figure 8. Hospital stay duration (postoperative days)

Studies by Benoist et al. [33], Lundby et al. [35], Sahoo et al. [38], Usman et al. [39], and Yehya et al. [40]

Figure 9. Mortality

Studies by Gleditsch et al. [31] and Lundby et al. [35]

Figure 10. Overall postoperative complications

Studies by Gleditsch et al. [31], Benoist et al. [33], and Lundby et al. [35]

Figure 11. Surgical site infection

Studies by Hidaka et al. [32], Lundby et al. [35], Sahoo et al. [38], Usman et al. [39], and Yehya et al. [40]

Figure 12. ROB-2: traffic light plot

Studies by Hidaka et al. [32], Lundby et al. [35], Mohammedy et al. [36], and Yehya et al. [40]

Figure 13. ROB-2: summary plot

Figure 14. ROBINS-I: traffic light plot

Studies by Gleditsch et al. [31], Benoist et al. [33], Luglio et al. [34], Raftopoulos et al. [37], Sahoo et al. [38], Usman et al. [39], and Bhandarwar et al. [41]

Figure 15. ROBINS-I: summary plot