Recurrence After Rectopexy: Insights From Magnetic Resonance Defecography

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Radiology

Background:

• Rectal prolapse recurrence after surgical repair is a significant clinical challenge.
• Previous research on recurrence risk factors has produced inconsistent findings.
• A limited number of factors have been assessed in prior recurrence risk studies.

Purpose of the Study:

• To identify preoperative biomarkers for rectal prolapse recurrence after rectopexy.
• To evaluate the utility of magnetic resonance defecography, anorectal manometry, and balloon expulsion testing in predicting recurrence.
• To integrate imaging findings with clinical factors for enhanced risk assessment.

Main Methods:

• Retrospective cohort study utilizing a prospectively maintained rectal prolapse registry.
• Analysis of 155 patients (145 female) who underwent robotic rectopexy between 2017 and 2025.
• Comparison of clinical, technical, and imaging parameters between patients with and without recurrence.

Main Results:

• The overall recurrence rate was 10.3% over a median follow-up of 1295 days.
• Diabetes mellitus was the only clinical factor significantly associated with recurrence (31.3% vs 5.8%, p < 0.001).
• Magnetic resonance defecography revealed associations between recurrence and cul-de-sac hernia (75% vs 42.9%, p = 0.015), enterocele (43.8% vs 16.7%, p = 0.018), and lower mean psoas muscle cross-sectional area (12.3 cm² vs 14.3 cm², p = 0.04).

Conclusions:

• This study is the first to combine MRI findings with clinical factors for rectal prolapse recurrence risk assessment.
• Potential predictors of recurrence include diabetes mellitus, enterocele, cul-de-sac hernia, and sarcopenia (indicated by low psoas muscle mass).
• Modifiable factors like diabetic control and sarcopenia present opportunities for preoperative optimization, warranting further large-scale validation studies.