[Comment] Quality of life, functional outcomes, and recurrence after resection rectopexy versus ventral mesh rectopexy for rectal prolapse repair

[Background] Resection rectopexy and ventral mesh rectopexy are widely accepted surgical options for the treatment of rectal prolapse; however, reports on long-term recurrence rates and functional outcomes are lacking. [Objective] We compared quality of life, long-term functional outcomes, and prolapse recurrence after resection rectopexy versus ventral mesh rectopexy. [Design] We retrospectively reviewed our prospectively collected rectal prolapse surgery database. [Settings] Patients who underwent resection rectopexy or ventral mesh rectopexy at our center between 2009 and 2016 were included. [Patients] Two hundred twenty patients were included, of whom 208 (94%) were women; 85 (39%) underwent resection rectopexy and 135 (61%) ventral mesh rectopexy. [Main outcome measures] Prolapse recurrence. [Results] The resection rectopexy group was younger (median 52 vs.60 years old, P＝0.02) and had more open procedures (20% vs.9%, P<0.001). After a median follow-up of 110 (interquartile range 94-146) months for resection rectopexy and 113 (87-137) months for ventral mesh rectopexy, recurrences occurred in 21 (26%) in the resection rectopexy and 50 (39%) in the ventral mesh rectopexy group (P＝0.041). The median time to recurrence was 44 (18-80) months in the resection rectopexy group and 28.5 (11.0-52.5) months in the ventral mesh rectopexy group (P＝0.14). There were no differences in the recurrence rate for primary prolapses in resection rectopexy versus ventral mesh rectopexy. The recurrence rate for redo prolapses was higher in the ventral mesh rectopexy group at 63% at 10 years versus 25% in the resection rectopexy group (P＝0.006). Functional outcomes were similar between the 2 groups. [Limitations] Retrospective review, recall bias. [Conclusions] Long-term quality of life and functional outcomes after resection rectopexy and ventral mesh rectopexy were comparable. Ventral mesh rectopexy was associated with a higher prolapse recurrence rate after recurrent rectal prolapse repair.