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Trends for the Surgical Management of Rectal Prolapse in the Elderly: A Contemporary Analysis of the National Quality Improvement Program
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DOI：10.1097/DCR.0000000000003630.png)
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Abstract
En 中文
BACKGROUND: Traditionally, the management of rectal prolapse in the elderly involved a perineal approach to repair. However, management paradigms have evolved, and the use of the transabdominal approach may be as safe as the perineal approach in elderly patients. OBJECTIVE: To provide a contemporary analysis of early postoperative outcomes and trends in the surgical management of rectal prolapse. DESIGN: This was a retrospective review of a large multicenter database. SETTING: The National Surgical Quality Improvement Program captured data from 702 participating sites. PATIENTS: All patients aged 70 years or older who underwent surgical repair of rectal prolapse from 2005 to 2022 were included for review. INTERVENTION: Surgical approach used to treat prolapse is defined as open transabdominal, minimally invasive transabdominal, and perineal. MAIN OUTCOME MEASURES: Temporal trends in the surgical approach used to treat rectal prolapse and rates of 30-day major and minor complications. RESULTS: A total of 9664 patients were analyzed who underwent rectal prolapse repair via perineal (72%), minimally invasive (19%), or open approach (9%). Surgical trends demonstrated the proportion of open approaches decreased from a high of 16.5% to 8.1% and that of perineal approaches decreased from 92.9% to 67.0%. In contrast, the proportion of minimally invasive procedures increased from 0.0% to 24.9%. There were no differences in major complication rates among the 3 approaches, but a higher mortality rate was seen for the perineal approach (1.7%) than for the minimally invasive approach (0.5%), and a higher minor complication rate was seen for open (11.1%) than for minimally invasive (5.8%) and perineal (6.0%) approaches. LIMITATIONS: This was a retrospective database study with limited details regarding surgical procedures and no long-term follow-up data beyond 30 days. CONCLUSIONS: The minimally invasive approach appears to be the safest repair method and has gained significant popularity in recent years among the elderly population. However, the perineal approach remains the most commonly used approach despite evolving trends.
Keywords:
Benign colorectal
Minimally invasive rectopexy
Rectal prolapse
Rectopexy
Surgical trends
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