EP347 - Trends In Rectal Prolapse Surgery In the Robotic Era: A United States National Inpatient Sample Analysis

Sunday, May 11, 2025

9:44 AM – 9:49 AM PT

Location: Monitor 8, Sails Pavilion, Upper Level

ePoster Presenter(s)

Lindsay Welton, MD (she/her/hers)

General Surgery Resident
University of Minnesota
University of Minnesota
Minneapolis, Minnesota, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Lauren Weaver, MD

Resident
University of Minnesota
University of Minnesota
Minneapolis, MN, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
CQ

Charles Quinn, n/a

Medical Student
University of Minnesota Medical School
Minneapolis, Minnesota, United States

Disclosure information not submitted.
Sean H. Nguyen, MD (he/him/his)

Resident
University of Minnesota
Minneapolis, MN, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
ZL

Zachary Leslie, n/a

Student
Nonexistent
Minneapolis, Minnesota, United States

Disclosure information not submitted.
PG

Paolo Goffredo, MD (he/him/his)

Assistant Professor
University of Minnesota
Minneapolis, MN, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Wolfgang Gaertner, MD, MSc, MBA

Professor and Chief, Colon & Rectal Surgery
University of Minnesota
University of Minnesota
Minneapolis, Minnesota, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.
GM

Genevieve B. Melton, MD, PhD

Professor of Surgery
Univeristy of Minnesota
Minneapolis, Minnesota, United States

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This individual has no financial relationships with ineligible companies.
SI

Sayeed Ikramuddin, MD, MHA

Professor of Surgery
University of Minnesota
Minneapolis, Minnesota, United States

Disclosure information not submitted.

Senior Author(s)

Amy J. Thorsen, MD (she/her/hers)

Associate Professor of Surgery
University of Minnesota
Hopkins, Minnesota, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Lindsay Welton, MD: This individual has no financial relationships with ineligible companies.

Lauren Weaver, MD: This individual has no financial relationships with ineligible companies.

Sean H. Nguyen, MD: This individual has no financial relationships with ineligible companies.

Paolo Goffredo, MD: This individual has no financial relationships with ineligible companies.

Wolfgang Gaertner, MD, MSc, MBA: This individual has no relevant relationships with ineligible companies.

Genevieve B. Melton, MD, PhD: This individual has no financial relationships with ineligible companies.

Amy J. Thorsen, MD: This individual has no financial relationships with ineligible companies.

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Purpose/Background: Despite being a benign condition, rectal prolapse (RP) can significantly impact patients’ quality of life. While operative intervention represents the only curative treatment, there is a lack of consensus regarding optimal surgical management. Over the past decade, procedures have evolved to better address concomitant multicompartment pelvic organ prolapse such as robotic ventral rectopexy +/- sacrocolpopexy to improve recurrence rates, functional results, and recovery. However, utilization of these more refined techniques is unclear. The aim of this study was to describe trends in patterns of care within a U.S. population-based cohort.

Methods/Interventions: The National Inpatient Sample was queried from 2016-2021 for adults diagnosed with RP who underwent corrective surgery. Operative interventions were grouped based on procedure type (rectopexy +/- resection, abdominal resection alone (sigmoidectomy or proctectomy) or Delorme/Altemeier), and further categorized by approach (open, minimally invasive surgery (MIS) including laparoscopic and robotic, or perineal), use of mesh, and multidisciplinary procedure (if repair concurrently coded with urologic or gynecologic procedure). Analysis was performed using STATA 18.0 MP. Survey weighted negative binomial regression adjusting for age and sex was used to report trends in procedures. Logistic regression was used to estimate likelihood of robotic approach adjusting for patient factors and comorbidities.

Results/Outcomes: Of the 10,232 patients (92% female, mean age 67 [SD +/- 18] years) underwent rectopexy +/- resection (54%), abdominal resection alone (24%), and Altemeier/Delorme (22%). Open and MIS approaches had equal rates of 40%, followed by perineal approach (20%). Over the study period there were significant changes in the frequency of surgical procedures and approaches (p < 0.001). Abdominal resection alone decreased by 14%. MIS increased 12% overall (with a 3% decline in laparoscopy but a 15% rise in robotic surgery), whereas open approach decreased by 19%. Furthermore, the 2016 incidence rate ratio of open approach to robotic repairs was 1.92 [CI: 1.35-2.71] p< 0.001 which narrowed to 0.87 p=0.411 by 2021 (Figure 1). Perineal approach increased 7% and was utilized mostly in the elderly, accounting for 75% of operations for patients ≥70 years. Rate of mesh use increased by 12% (4% in 2016 to 16% in 2021), and multidisciplinary surgeries accounted for only ~5% of total annual procedure volume. Logistic regression showed patients ≥80 years, or with active smoking history, hypertension, anemia, or chronic kidney disease were significantly less likely to have robotic surgery (p < 0.05).

Conclusion/Discussion: In this large national database review of patients undergoing operative management for RP, abdominal resection alone has steadily declined. Meanwhile, minimally invasive procedures have increased, especially the robotic approach among younger healthier patients. By 2021, patients were equally as likely to undergo either an open or a robotic repair, which is a significant shift from 2016. Perineal procedures continue to account for the vast majority of operations in the elderly population despite studies suggesting superiority of MIS abdominal repairs. Although evidence suggests that mesh use and concomitant multicompartment pelvic organ repair has been associated with improved functional outcomes and less RP recurrence rates, these procedures remain infrequently performed in the United States.