Matthew Skancke, Dr, Richard Amdur, PhD, Bindu Umapathi, Dr, Vincent Obias, Dr. George Washington University
Background: While uncommon, rectal prolapse is a disabling condition affecting older females. In a small subset of patients, concomitant organ prolapses with or without incarceration can lead to significant morbidity. As the field of laparoscopy has evolved, minimally invasive surgical options for rectal prolapse have led to improved quality and reduced morbidity for patients suffering this debilitating disease.
Methods: The 2012-2015 ACS-NSQIP databases was queried for patients undergoing a traditional or minimally invasive rectopexy based on CPT codes (45400,45402,45540,45541 and 45550). Emergent cases and patients with preoperative infections or inflammatory states were excluded. The primary outcome of interest was a 30-day postoperative composite morbidity score. Statistical analysis incorporated multivariate analysis and binomial logistic regression with p<0.05 holding significance.
Results: These inclusion and exclusion criteria identified 2393 patients undergoing traditional (1113) and minimally invasive (1280) rectopexy for prolapse between 2012 and 2015. Patients undergoing traditional rectopexy were older (p<0.001), had a higher body mass index (p=0.018), more comorbid conditions (diabetes, COPD, hypertension) and less functional independence (p=0.026). Patients undergoing a traditional rectopexy had a higher composite morbidity incidence of 13.2% vs. 8% for minimally invasive rectopexy (p<0.001). Specifically, minimally invasive rectopexy patients had a 2.63% reduction in wound complications (p=0.002) and a shorter hospital stay (3.3 days vs. 4.3 days, p<0.001) compared to a traditional rectopexy. Readmission rates were also 2.6% lower in the minimally invasive group (p=0.015). After controlling for the differences in the cohorts, a minimally invasive approach was a significant protective factor against the incidence of 30-day postoperative morbidity (OR 0.476, p<0.001).
Conclusion: A minimally invasive rectopexy has improved 30-day postoperative morbidity compared to a traditional rectopexy and should be strongly considered for the treatment of rectal prolapse.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88478
Program Number: P216
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster