Epidemiologic aspects of rectal prolapse: a population-based study of surgical treatment
Jannica Smedberg, W I lhelm Graf, Klas Pekkari, Fredrik Hjern, Magnus Sundbom, Anne Örtqvist RosinAbstract
Introduction
Evidence guiding the optimal surgical approach for rectal prolapse remains limited. This study aimed to describe national, real-world patterns of rectal prolapse surgery and compare outcomes across operative methods using a population-based dataset.
Methods
All adults undergoing first-time rectal prolapse surgery in Sweden between 2010 and 2023 were identified through the Swedish National Patient Register. Procedures were categorized as rectopexy, rectopexy with resection, perineal methods, or other procedures. Age- and sex-specific incidence rates were calculated. Cox regression analyses generated age- and sex-adjusted hazard ratios (aHRs) with 95% confidence intervals for complications within 90 days and reoperations of rectal prolapse, using reoperation as surrogate for recurrence. Rectopexy was defined as the reference category in the analyses.
Results
A total of 3275 patients were included, with a female-to-male ratio of 12:1. The overall annual incidence of surgery was 2.9 per 100 000 adults (0.4 for men; 5.4 for women), increasing markedly with age in the female population. The overall reoperation rate was 16%. Compared with rectopexy, the aHR for reoperation was 1.09 (0.63–1.87) for rectopexy with resection, 2.67 (2.16–3.29) for perineal methods, and 2.10 (1.65–2.68) for other procedures. Thirty-day mortality was 0.8%, and 1.6% experienced complications within 90 days. The aHR for complications was 4.32 (1.47–12.74) for rectopexy with resection, 1.59 (0.73–3.48) for perineal methods, and 3.87 (1.98–7.58) for other procedures.
Discussion
Rectal prolapse surgery is most common among older women. Although overall complication and mortality rates were low, perineal methods and other procedures were associated with higher risk of recurrence compared with rectopexy.