High versus low take‐off rectal prolapse: Outcomes of tailored surgery
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2025
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| author | Mohit Satish Gupta Usman Mateen Nicola Davies Andrew Clarke |
| author_facet | Mohit Satish Gupta Usman Mateen Nicola Davies Andrew Clarke Mohit Satish Gupta Usman Mateen Nicola Davies Andrew Clarke |
| collection | Wiley Open Access |
| contents | High versus low take‐off rectal prolapse: Outcomes of tailored surgery Mohit Satish Gupta Usman Mateen Nicola Davies Andrew Clarke Colorectal Disease Abstract Background Full‐thickness rectal prolapse (FTRP) is heterogeneous, with outcomes varying despite similar anatomy. Cooper et al. proposed a radiological classification based on prolapse ‘take‐off’ level on defecating proctography (DPG), hypothesising that high take‐off (HTO) and low take‐off (LTO) phenotypes may respond differently to abdominal versus perineal repair. This hypothesis has not previously been tested in a clinical cohort. Methods A retrospective observational cohort study was performed across three hospitals over 12 years (2012–2024). Patients undergoing laparoscopic ventral mesh rectopexy (VMR), as first standardised by D'Hoore et al. [3] or Delorme's procedure with DPG‐defined take‐off were included. Outcomes were compared between procedures, matched versus unmatched surgery, and HTO versus LTO. The primary end‐point was anatomical recurrence. Secondary end‐points included radiological findings and symptom profiles by phenotype. Results Of 108 patients, 71 (52 VMR, 19 Delorme's) had evaluable DPG and were included in phenotype analysis (HTO, n = 28; LTO, n = 43). Overall recurrence was 15.5%. Recurrence was lower after VMR than Delorme's (13.5% vs. 21.1%, p = 0.47) and in matched versus unmatched surgery (12.8% vs. 20.8%, p = 0.53), though not statistically significant. Within VMR, recurrence was lower in HTO than LTO (8.3% vs. 17.9%). HTO was significantly associated with enterocele (71.4% vs. 44.2%, p = 0.030) and greater perineal discomfort (85.7% vs. 55.8%, p = 0.010), whereas LTO more frequently presented with incontinence/urgency. Conclusion This first clinical validation of the high/low take‐off concept demonstrates phenotype‐specific differences in radiology, symptoms, and surgical outcomes. Tailoring surgery to prolapse phenotype may reduce recurrence and guide personalised operative planning. Prospective, multicentre studies with quality‐of‐life outcomes are warranted. 10.1111/codi.70330 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| doi_str_mv | 10.1111/codi.70330 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_codi_70330 |
| institution | Wiley Open Access |
| license_str_mv | http://onlinelibrary.wiley.com/termsAndConditions#vor |
| publishDate | 2025 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | High versus low take‐off rectal prolapse: Outcomes of tailored surgery Mohit Satish Gupta Usman Mateen Nicola Davies Andrew Clarke Colorectal Disease High versus low take‐off rectal prolapse: Outcomes of tailored surgery Mohit Satish Gupta Usman Mateen Nicola Davies Andrew Clarke Colorectal Disease Abstract Background Full‐thickness rectal prolapse (FTRP) is heterogeneous, with outcomes varying despite similar anatomy. Cooper et al. proposed a radiological classification based on prolapse ‘take‐off’ level on defecating proctography (DPG), hypothesising that high take‐off (HTO) and low take‐off (LTO) phenotypes may respond differently to abdominal versus perineal repair. This hypothesis has not previously been tested in a clinical cohort. Methods A retrospective observational cohort study was performed across three hospitals over 12 years (2012–2024). Patients undergoing laparoscopic ventral mesh rectopexy (VMR), as first standardised by D'Hoore et al. [3] or Delorme's procedure with DPG‐defined take‐off were included. Outcomes were compared between procedures, matched versus unmatched surgery, and HTO versus LTO. The primary end‐point was anatomical recurrence. Secondary end‐points included radiological findings and symptom profiles by phenotype. Results Of 108 patients, 71 (52 VMR, 19 Delorme's) had evaluable DPG and were included in phenotype analysis (HTO, n = 28; LTO, n = 43). Overall recurrence was 15.5%. Recurrence was lower after VMR than Delorme's (13.5% vs. 21.1%, p = 0.47) and in matched versus unmatched surgery (12.8% vs. 20.8%, p = 0.53), though not statistically significant. Within VMR, recurrence was lower in HTO than LTO (8.3% vs. 17.9%). HTO was significantly associated with enterocele (71.4% vs. 44.2%, p = 0.030) and greater perineal discomfort (85.7% vs. 55.8%, p = 0.010), whereas LTO more frequently presented with incontinence/urgency. Conclusion This first clinical validation of the high/low take‐off concept demonstrates phenotype‐specific differences in radiology, symptoms, and surgical outcomes. Tailoring surgery to prolapse phenotype may reduce recurrence and guide personalised operative planning. Prospective, multicentre studies with quality‐of‐life outcomes are warranted. 10.1111/codi.70330 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| title | High versus low take‐off rectal prolapse: Outcomes of tailored surgery |
| topic | Colorectal Disease |
| url | https://onlinelibrary.wiley.com/doi/10.1111/codi.70330 |