O140 Delorme vs. Altemeier: a systematic review and meta-analysis comparing the common perineal procedures for rectal prolapse

Abstract

Abstract Introduction Rectal prolapse is a particularly distressing condition for patients, and there is no consensus yet as to the best surgical option for treatment. In this systematic review and meta-analysis we compared the outcomes for the two most commonly employed perineal operations for rectal prolapse – Delorme's and Altemeier's procedure. Methods A systematic search of multiple electronic databases was conducted. Peri- and post-operative outcomes following Delorme's and Altemeier's procedures were extracted. Primary outcomes included recurrence rate, anastomotic leak rate, and length of hospital stay. The secondary outcomes were operation time, volume of blood loss and length of hospital stay. Revman 5.3 was used to perform statistical analysis. Results 10 studies including a total of 605 patients were selected. Recurrence (OR: 0.66; 95% CI [0.44–0.99], P= 0.05) and anastomotic leak (RD: 0.05; 95% CI [0.00–0.09], P= 0.03) were found to be significantly less in the Altemeier group than in the Delorme group. However on subgroup analysis Altemeiers with plasty (perineoplasty or levatoroplasty) failed to show significant differences in comparison to Delorme's. Hospital stay was significantly more after Altemeiers procedure than after Delorme procedure (MD: 3.05, 95% CI [0.95–5.51], p=0.004). No significant difference was found with respect to operative time, intra operative blood loss and mortality rates. Conclusion Our study indicates that between the two common perineal procedures, Altemeier's operation has better outcomes. Future high quality RCTs with long follow up are required to corroborate these findings.