Comparison between perineal and abdominal approaches for the surgical treatment of recurrent external rectal prolapse: a systematic review and meta-analysis.

Purpose: Although surgery is the most effective treatment for rectal prolapse, a risk of recurrence reported in literature is 6-27%. The aim of this meta-analysis is to compare the abdominal and perineal approach for surgical treatment of recurrent external rectal prolapse.

Methods: A systematic search of PubMed and Embase was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A comprehensive literature search of PubMed and Embase was conducted from January 2000 to May 2024, for studies reporting surgery for recurrent external rectal prolapse. The primary outcome was the recurrence at the last available follow-up. Secondary endpoints included surgical complications and length of postoperative hospitalization.

Results: Nine studies, with a total of 531 patients, were included in the analysis. The overall recurrence rate among the studies was 26.3% at a mean follow-up time of 30.5 months. The proportional meta-analysis showed a recurrence rate of 27.9% (95% CI 22.54 to 33.85, I 75.1%, p = 0.0012) after perineal surgery and of 15.6% (95% CI 11.43 to 20.64, I 63.7%, p = 0.016) after abdominal surgery. Comparing the two approaches, the meta-analysis showed an OR of 0.66 (95% CI 0.41 to 1.17, I 66.5%, p = 0.029). The OR for complications was 1.44 (95% CI 0.77 to 2.70, I 0.0%, p = 0.945), while SMD for length of hospital stay was 0.49 (95% CI 0.20 to 0.79, I- 67.9%, p = 0.077).

Conclusions: Our meta-analysis revealed that the recurrence rate for the perineal approach was almost double the recurrence rate for the abdominal approach. More randomized trials are needed to determine which is the best approach for patients with recurrent external rectal prolapse.