Laparoscopic Resection Rectopexy Versus Delorme's Procedure In Full-Thickness Rectal Prolapse - A Randomized Multicenter Trial (DELORES-RCT).

IF 7.5 1区医学 Q1 SURGERY

Annals of surgery Pub Date : 2025-03-28 DOI:10.1097/SLA.0000000000006708

Florian Herrle, Flavius Sandra-Petrescu, Simone Rothenhoefer, Julia Hardt, Steffen Seyfried, Andreas Joos, Alexander Herold, Dieter Bussen, Stefan Post, Marion Brunner, Alois Fürst, Gianluca De Santo, Robert Siegel, Martin Strik, Michael Sprossmann, Eugen Berg, Andreas Ommer, Martin K Walz, Claudia Benecke, Ralf Bouchard, Tobias Keck, Dirk Weimann, Thomas Schiedeck, Nicolas Demartines, Dieter Hanloser, Anja Sander, Lukas D Sauer, Christina Klose, Meinhard Kieser, Markus Diener, Rosa Klotz, Christoph Reissfelder, Peter Kienle

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引用次数: 0

Abstract

Objective: The DELORES trial investigated whether laparoscopic resection rectopexy (LRR) is superior to Delorme's procedure (DP) in full-thickness rectal prolapse.

Summary of background data: Multiple perineal and transabdominal procedures are current practice for rectal prolapse surgery. Evidence from adequately designed randomized studies addressing the question of which of these procedures are superior in terms of recurrence and bowel function is lacking.

Methods: DELORES was a randomized, observer-blinded, expertise-based multicenter trial. Patients with full-thickness rectal prolapse were eligible. Primary outcome was time to recurrence of full-thickness rectal prolapse within 24 months after primary surgery. Main secondary endpoints were morbidity, hospital stay, quality of life, constipation and fecal incontinence. (DRKS00000482).

Results: A total of 358 patients were screened between September 2010 and January 2016. Based on screening, 70 patients were randomized and 65 were included in the analysis (33 LRR and 32 DP procedures). Median follow-up was 23.9 months. Analysis of the primary outcome showed that LRR was superior to DP ( P =0.0012). During the 24-month follow-up, 8.2% of patients in the LRR group had a full-thickness prolapse recurrence versus 42.8% in the DP group. Median time to recurrence was 11.9 months for LRR and 8.2 months for DP. Median duration of surgery was 212 min (LRR) versus 77 min (DP). Overall postoperative morbidity was low. The reoperation rate was higher for DP (0% LRR vs. 33.3% DP). Quality of life (FIQL) and incontinence scores (Wexner) were more favorable for LRR at 24-month follow-up.

Conclusion: Laparoscopic resection rectopexy is superior to Delorme's procedure in terms of recurrence and has favorable functional results.

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来源期刊

Annals of surgery 医学-外科

CiteScore

14.40

自引率

4.40%

发文量

687

审稿时长

4 months

期刊介绍： The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.