Open vs laparoscopic repair of full-thickness rectal prolapse: a re-meta-analysis

Objective A re-meta-analysis of available data within the published literature comparing laparoscopic rectopexy (LR) with open repair (OR). Method We searched MEDLINE, EMBASE, CINAHL, PubMed and the Cochrane databases from January 1990 to October 2008. We searched the following MESH terms: 'laparoscopy', 'prolapse' and 'rectal prolapse'. We used the following text words: 'rectopexy', 'haemorrhoids', 'minimally invasive' and 'keyhole surgery'. The bibliography of selected trials and a Cochrane review was scrutinized and relevant references obtained. Selected trials were analysed to conduct a meta-analysis. Results Twelve comparative studies on 688 patients qualified for the review. There were 330 patients in LR group and 358 in the OR group. LR takes longer to perform compared with OR. This difference was statistically significant [random effects model: standardized mean difference (SMD) 1.63, 95% CI (1.14-2.12), z = 6.56, P < 0.001]. There was a significant reduction in hospital stay between LR vs OR [random effects model: SMD -1.75, 95% CI (-2.45 to -1.05), z = -4.90, P < 0.001]. There was no statistical difference relating to morbidity, constipation, incontinence or mortality between the two groups. Conclusion laparoscopic rectopexy is a safe and effective modality and is comparable to OR, however, there is still a paucity of randomized controlled trials within the literature regarding this subject. Until these trials are conducted, we would advise caution in deriving absolute conclusions.