Evaluation of treatment methods for complete rectal prolapse: a real world study
Objective:To evaluate the clinical efficacy of common treatment methods (injection therapy, transabdominal surgery, and transperineal surgery) for complete rectal prolapse in the real world.Methods:A retrospective cohort study was conducted on the clinical data of 174 patients with complete rectal prolapse who underwent inpatient treatment at the Department of Proctology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences from January 1, 2013 to December 31, 2021. Among them, there were 86 males and 88 females, with a median age of 58 (range, 32-72) years. Using the real-world research method, taking electronic medical records and follow-up data as data sources, the patients with complete rectal prolapse were divided into an injection treatment group, a transabdominal operation group, and a transperineal operation group according to the treatment method used. The patient's medical records and follow-up data were analyzed, and the disease characteristics of each group were compared. The tendency score matching method (PSM) was used to control the confounding factors. The main outcome indicators (cure rate, total effective rate, recurrence rate, and postoperative symptom score) and secondary outcome indicators (complication rate, improvement rate of constipation and incontinence, treatment operation time, bleeding volume, fasting days after treatment, days of intravenous antibiotics, defecation days after treatment, length of hospital stay, and cost) were compared among the three groups.Results:There were 110 patients in the injection treatment group, 35 in the transabdominal operation group, and 29 in the transperineal operation group. There were significant differences in age, sex, rectal prolapse surgery history, and prolapse length among the three groups (P＜0.05 for all). The proportions of men and women in the injection group and the transabdominal operation group were close, but they were significantly different in the transperineal operation group (1∶3). The median age of the transperineal operation group was 70 (range, 59-81) years, which was significantly higher than those in the other two groups. The percentage of patients with a history of rectal prolapse surgery in the transabdominal group was the largest (54.3%), which was significantly higher than those in the other two groups. The average prolapse length in the transabdominal group was the longest (7.20±2.65) cm, and it was the shortest in the injection group (5.59±2.82) cm. There was no significant differences in the cure rate, total effective rate, postoperative complication rate, or recurrence rate among the three groups (P＞0.05 for all). The recurrence rate in the injection group was 39.2%, and it was 23.8% in the transabdominal group and 46.7% in the perineal group.Conclusion:Injection therapy for the treatment of complete rectal prolapse is cost-effective and safe, with fast postoperative recovery and the lowest incidence of complications. However, it has a relatively higher postoperative recurrence rate. Transabdominal surgery is more expensive, with relatively slower postoperative recovery and the highest incidence of complications, but it has the lowest postoperative recurrence rate. Transperineal surgery has a comparable incidence of short-term complications to abdominal surgery, but with the highest postoperative recurrence rate.
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