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

Abstract 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. Methods: This was a retrospective comparative analysis evaluating outcomes of elderly patients, age ≥ 70 years, undergoing surgical correction of full thickness rectal prolapse at a single tertiary hospital between 2010 – 2023. Patients must have undergone minimally invasive rectopexy or perineal rectosigmoidectomy (Altemeier). Primary outcomes evaluated included 30-day mortality and complication rates. Results: A total of 55 patients were included, 42 who underwent minimally invasive rectopexy (MIR) and 13 who underwent perineal rectosigmoidectomy (PR). The average age of all patients was 79.8 ± 6.4 years, average body mass index (BMI) was 22.5 ± 3.7, and 49 (89.1%) patients were female. Patients that underwent MIR had a significantly lower 30-day complication rate compared to PR patients (11.9% vs. 53.8%, respectively; p=0.001). There were 0 (0%) deaths in either group within 30 days of repair. PR patients had similar recurrence rates to MIR patients with median interval to first documented recurrence of 6.0 (range 0.2-24.5) months. Rate of normal bowel function achieved at most recent follow-up was significantly higher for MIR patients compared to PR (76.2% vs. 30.8%, respectively; p=0.003). Discussion: MIR approach to prolapse repair is safe and feasible in elderly patients with lower 30-day complication rate and comparable mortality rates compared to patients undergoing PR. Additionally, overall, early functional outcomes were better after MIR.