{"title":"会阴直肠乙状结肠切除术和提上睑肌成形术后的复发：综述和荟萃分析","authors":"Sahil Sharma , Tyler McKechnie , Jigish Khamar , Simarpreet Ichhpuniani , Cagla Eskicioglu","doi":"10.1016/j.hsr.2024.100159","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Full-thickness rectal prolapse remains a challenging pathology to correct surgically with significant recurrence rates. Among perineal approaches, the proctosigmoidectomy with levatorplasty, commonly referred to as the Altemeier procedure is frequently performed. The addition of levatorplasty has been postulated to improve recurrence rates, however, its efficacy varies across studies. The aim of this study was to systematically review recurrence rates following proctosigmoidectomy with levatorplasty, and to meta-analyze pooled data comparing recurrence rates between proctosigmoidectomy with and without a levatorplasty.</p></div><div><h3>Methods</h3><p>A search of EMBASE, OVID Medline, and CENTRAL was performed from database inception to October 2021 aimed at identifying studies investigating recurrences of rectal prolapse following proctosigmoidectomy with levatorplasty. Primary endpoint was recurrence of rectal prolapse. Articles that did not report this endpoint or did not evaluate proctosigmoidectomy with levatorplasty were excluded. A pairwise meta-analysis was performed using Mantel-Haenszel random effects.</p></div><div><h3>Results</h3><p>From 200 citations, 14 primary studies met inclusion criteria. A total of 620 patients (88.9% female, mean age: 71 years) underwent proctosigmoidectomy with levatorplasty, and 117 without levatorplasty. Of the patients undergoing levatorplasty, 86 (13.8%) experienced a recurrence. Mean follow up was 46 months. Meta-analysis comparing recurrence rates between proctosigmoidectomy with and without levatorplasty demonstrated no significant difference (RR 0.80, 0.92, 95% CI 0.32–2.59, <em>P</em> = 0.87, I<sup>2</sup> = 77%). Narrative review of postoperative quality of life metrics demonstrated decreased incontinence with levatorplasty as measured by Wexner and ICIQ-SIF scores.</p></div><div><h3>Discussion</h3><p>The addition of a levatorplasty does not significantly reduce the risk of recurrent rectal prolapse after proctosigmoidectomy, however it may improve postoperative continence.</p></div>","PeriodicalId":73214,"journal":{"name":"Health sciences review (Oxford, England)","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772632024000126/pdfft?md5=0bff61fa4e5809c0a358e299824171a3&pid=1-s2.0-S2772632024000126-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Recurrence following perineal proctosigmoidectomy with levatorplasty: Review and meta-analyses\",\"authors\":\"Sahil Sharma , Tyler McKechnie , Jigish Khamar , Simarpreet Ichhpuniani , Cagla Eskicioglu\",\"doi\":\"10.1016/j.hsr.2024.100159\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Full-thickness rectal prolapse remains a challenging pathology to correct surgically with significant recurrence rates. Among perineal approaches, the proctosigmoidectomy with levatorplasty, commonly referred to as the Altemeier procedure is frequently performed. The addition of levatorplasty has been postulated to improve recurrence rates, however, its efficacy varies across studies. The aim of this study was to systematically review recurrence rates following proctosigmoidectomy with levatorplasty, and to meta-analyze pooled data comparing recurrence rates between proctosigmoidectomy with and without a levatorplasty.</p></div><div><h3>Methods</h3><p>A search of EMBASE, OVID Medline, and CENTRAL was performed from database inception to October 2021 aimed at identifying studies investigating recurrences of rectal prolapse following proctosigmoidectomy with levatorplasty. Primary endpoint was recurrence of rectal prolapse. Articles that did not report this endpoint or did not evaluate proctosigmoidectomy with levatorplasty were excluded. A pairwise meta-analysis was performed using Mantel-Haenszel random effects.</p></div><div><h3>Results</h3><p>From 200 citations, 14 primary studies met inclusion criteria. A total of 620 patients (88.9% female, mean age: 71 years) underwent proctosigmoidectomy with levatorplasty, and 117 without levatorplasty. Of the patients undergoing levatorplasty, 86 (13.8%) experienced a recurrence. Mean follow up was 46 months. Meta-analysis comparing recurrence rates between proctosigmoidectomy with and without levatorplasty demonstrated no significant difference (RR 0.80, 0.92, 95% CI 0.32–2.59, <em>P</em> = 0.87, I<sup>2</sup> = 77%). Narrative review of postoperative quality of life metrics demonstrated decreased incontinence with levatorplasty as measured by Wexner and ICIQ-SIF scores.</p></div><div><h3>Discussion</h3><p>The addition of a levatorplasty does not significantly reduce the risk of recurrent rectal prolapse after proctosigmoidectomy, however it may improve postoperative continence.</p></div>\",\"PeriodicalId\":73214,\"journal\":{\"name\":\"Health sciences review (Oxford, England)\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-03-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2772632024000126/pdfft?md5=0bff61fa4e5809c0a358e299824171a3&pid=1-s2.0-S2772632024000126-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Health sciences review (Oxford, England)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2772632024000126\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health sciences review (Oxford, England)","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2772632024000126","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景全厚直肠脱垂仍然是一种极具挑战性的病理，手术矫正复发率很高。在会阴部手术方法中，通常采用直肠乙状结肠切除术联合上提肌成形术（俗称 Altemeier 术）。据推测，加用提上睑肌成形术可提高复发率，但不同研究的疗效各不相同。本研究旨在系统回顾直肠乙状结肠切除术联合上提肌成形术后的复发率，并对比较直肠乙状结肠切除术联合上提肌成形术与未联合上提肌成形术的复发率的汇总数据进行荟萃分析。方法从数据库建立之初到2021年10月，对EMBASE、OVID Medline和CENTRAL进行了检索，旨在确定调查直肠乙状结肠切除术联合上提肌成形术后直肠脱垂复发情况的研究。主要终点是直肠脱垂的复发。未报告该终点或未对直肠乙状结肠切除术联合提上睑肌成形术进行评估的文章被排除在外。采用 Mantel-Haenszel 随机效应进行了配对荟萃分析。共有620名患者（88.9%为女性，平均年龄：71岁）接受了直肠乙状结肠切除术和上睑提肌成形术，117名患者未接受上睑提肌成形术。在接受切除术的患者中，有 86 人（13.8%）复发。平均随访时间为 46 个月。比较直肠乙状结肠切除术与不进行上睑下垂成形术的复发率的 Meta 分析表明两者之间没有显著差异（RR 0.80、0.92、95% CI 0.32-2.59、P = 0.87、I2 = 77%）。根据Wexner和ICIQ-SIF评分，对术后生活质量指标的叙述性回顾显示，采用上睑下垂成形术后尿失禁减少。
Recurrence following perineal proctosigmoidectomy with levatorplasty: Review and meta-analyses
Background
Full-thickness rectal prolapse remains a challenging pathology to correct surgically with significant recurrence rates. Among perineal approaches, the proctosigmoidectomy with levatorplasty, commonly referred to as the Altemeier procedure is frequently performed. The addition of levatorplasty has been postulated to improve recurrence rates, however, its efficacy varies across studies. The aim of this study was to systematically review recurrence rates following proctosigmoidectomy with levatorplasty, and to meta-analyze pooled data comparing recurrence rates between proctosigmoidectomy with and without a levatorplasty.
Methods
A search of EMBASE, OVID Medline, and CENTRAL was performed from database inception to October 2021 aimed at identifying studies investigating recurrences of rectal prolapse following proctosigmoidectomy with levatorplasty. Primary endpoint was recurrence of rectal prolapse. Articles that did not report this endpoint or did not evaluate proctosigmoidectomy with levatorplasty were excluded. A pairwise meta-analysis was performed using Mantel-Haenszel random effects.
Results
From 200 citations, 14 primary studies met inclusion criteria. A total of 620 patients (88.9% female, mean age: 71 years) underwent proctosigmoidectomy with levatorplasty, and 117 without levatorplasty. Of the patients undergoing levatorplasty, 86 (13.8%) experienced a recurrence. Mean follow up was 46 months. Meta-analysis comparing recurrence rates between proctosigmoidectomy with and without levatorplasty demonstrated no significant difference (RR 0.80, 0.92, 95% CI 0.32–2.59, P = 0.87, I2 = 77%). Narrative review of postoperative quality of life metrics demonstrated decreased incontinence with levatorplasty as measured by Wexner and ICIQ-SIF scores.
Discussion
The addition of a levatorplasty does not significantly reduce the risk of recurrent rectal prolapse after proctosigmoidectomy, however it may improve postoperative continence.
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