Rectopexy with Sigmoidectomy for Rectal Prolapse: A Nationwide Analysis of Robotic-Assisted vs. Laparoscopic vs. Open Approach

Reza Fazl Alizadeh, MD, Zhobin Moghadamyeganeh, MD, Mark H Hannah, MD, John Gahagan, MD, Steven D Mills, MD, Joseph C Carmichael, MD, Alessio Pigazzi, MD, PhD, Michael J Stamos, MD. University of California, Irvine, Department of Surgery

INTRODUCTION: Sigmoidectomy with rectopexy is one of the most common procedures performed to correct rectal prolapse, and is largely accepted as the most durable procedure. In recent years, there has been increased utilization of minimally invasive approaches to perform this operation. The aim of this study was to investigate outcomes of these different surgical approaches in patients with rectal prolapse.

METHODS AND MATERIALS: The Nationwide Inpatient Sample (NIS) database were used to examine the short-term outcomes of patients with rectal prolapse undergoing sigmoidectomy with rectopexy operation from 2009 to 2012. Multivariate regression analysis was performed to compare open, laparoscopic and robotic approaches.

RESULTS: A total of 1,405 patients with the diagnosis of rectal prolapse underwent sigmoidectomy with rectopexy between 2009 and 2012. Among them, 809 (57.6%) underwent open surgery (OS), 480 (34.2%) laparoscopic surgery (LS), and 116 (8.2%) robotic surgery (RS). The conversion rate for LS was significantly higher compared to RS (11.7% vs. 0%, P<0.01). Overall mortality rate of patients who underwent OS, LS, and RS was 1.2%, 0%, and 0% respectively. Following risk adjustment, OS patients were found to have a significantly higher mortality compared to both minimally invasive approaches (P<0.01). Overall morbidity rate was also higher in OS patients compared to minimally invasive approaches (AOR: 1.40, P=0.03), but there was no significant difference in morbidity between LS and RS (AOR: 0.92, P=0.84). Mean length of hospitalization for OS, LS, and RS were 7,5, and 4 days respectively. Total hospital charges for OS, LS, and RS were $48,039, $52,147, and $55,749 respectively. Adjusted mean difference of total charge between OS and LS, and OS and RS were $4108, CI=(590-7627), P<0.05 and $7755, CI=(1744-3767), P<0.05, respectively.

CONCLUSIONS: Utilization of minimally invasive approaches for rectal prolapse surgery has increased from 26.6% in 2009 to 45.2% in 2012. Minimally invasive approaches to rectal prolapse are associated with decreased mortality and morbidity. There is no significant difference in mortality and morbidity of RS and LS, while the robotic approach has a significantly lower conversion rate compared to the laparoscopic approach.  Minimally invasive approaches decrease hospitalization duration and postoperative morbidity in the setting of increased hospital charges.  Large prospective studies are needed to validate these findings.

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