Concomitant Pelvic Organ Prolapse and Rectal Prolapse Repair : A Meta-analysis

Objectives: To systematically review the current data on the risk of perioperative complications following concomitant POP repair (sacrocolpexy or native tissue repair) and rectal prolapse (RP) surgery.

Methods: A thorough literature search encompassing all studies, including RCTs and cohort studies reporting on concomitant POP and RP repairs was conducted until January 2024. Included were studies comparing concomitant POP and RP surgery to either POP or RP surgery alone. The following databases were utilized during our search: Web of Science, PubMed, Embase, and Scopus. Our search focused on published articles addressing perioperative and 30-day complications such as surgical site infection, urinary retention, arrhythmia, renal failure, pulmonary thromboembolism after concomitant POP and RP surgery. These complications were stratified using the Calvin-Dindo classification. complications above class III were considered serious. Random effect models were employed to analyze the data and calculate the odds ratio for the occurrence of any- and severe complications.

Results: A total of 3974 articles were identified. After removing duplicates, 1144 articles underwent abstract screening, leading to the selection of 38 studies for full-text review. Ultimately, seven articles met the inclusion criteria for the final analysis. All studies that met the inclusion criteria were cohort studies. The combined cohort of these studies included 16,471 women who underwent surgical procedures for RP surgery or POP repair; of these, 843 women underwent concurrent surgeries, 7,808 underwent isolated POP repair, and 7,820 had isolated RP surgery. (Table 1)
The analysis indicated that total complication rates for the concomitant surgery group were not significantly higher compared to either POP repair alone (OR: 0.78, 95% CI [0.56, 1.09], p = 0.14, I2 = 0%) or RP surgery alone (OR: 0.79, 95% CI [0.49, 1.25], p = 0.31, I2 = 48%). Pooled analysis revealed that non-concomitant surgery did not significantly decrease risk of complications (OR: 0.74, 95% CI [0.53, 1.03], p = 0.07, I2 = 35%).
Regarding serious complications, there was no significant increase in risk for patients undergoing concomitant surgery compared to POP (OR: 0.70, 95% CI [0.43, 1.27], p = 0.16, I2 = 0%) or RP surgery alone (OR: 0.86, 95% CI [0.54, 1.35], p = 0.50, I2 = 39%). Furthermore, a pooled analysis comparing concomitant and non-concomitant cases showed no significant difference in serious complications (OR: 0.79, 95% CI [0.54, 1.14], p = 0.21, I2 = 22%).

Conclusions:

Conclusion: The findings of this meta-analysis reveal that concomitant POP and RP surgeries do not increase the risk of complications compared to performing these procedures alone.