Minimally Invasive Mesh Rectopexy versus Perineal Rectosigmoidectomy in the Elderly: a Retrospective Comparative Analysis

Aim: The aim of this study was to compare early and intermediate perioperative outcomes after rectal prolapse repair in elderly patients undergoing either minimally invasive mesh rectopexy or perineal rectosigmoidectomy (PR). Method: This retrospective comparative analysis evaluated the outcomes of elderly patients (age ≥70 years) who underwent surgical correction of full-thickness rectal prolapse at a single tertiary hospital between 2010 and 2023. Patients included in the study had undergone either minimally invasive rectopexy (MIR) or PR (Altemeier procedure). The primary outcomes assessed were 30-day mortality and complication rates. Results: A total of 55 patients were included, with 42 who underwent MIR and 13 who underwent PR. The average age of all the patients was 79.8±6.4 years, and the average body mass index was 22.5±3.7. Most patients (49, 89.1%) were women. Patients who underwent MIR had a significantly lower 30-day complication rate than those who underwent PR (11.9% vs. 53.8%, respectively; p=0.001). No deaths occurred in either group within 30 days of the procedure. Patients who underwent PR had similar recurrence rates to those who underwent MIR, with a median interval to the first documented recurrence of 6.0 months (range: 0.2-24.5 months). The rate of normal bowel function achieved at the most recent follow-up was significantly higher in patients who underwent MIR than in those who underwent PR (76.2% vs. 30.8%, respectively; p=0.003). Conclusion: The MIR approach to prolapse repair is safe and feasible in elderly patients, with a lower 30-day complication rate and comparable mortality rates than PR. Additionally, early functional outcomes are better after MIR.