D’Hoore, André

BACKGROUND: Ventral rectopexy has become increasingly used in the surgical management of rectal prolapse. There is a need for a contemporary evaluation of the role of the procedure and a description of its use in clinical practice. OBJECTIVE: To create an international consensus on ventral rectopexy. DESIGN: An expert panel undertook a scoping review of the literature to identify subject domains of interest. Literature reviews were completed for each domain with subsequent development of evidence-based and practice-based statements. These statements were compiled and reviewed by the group over a total of 9 meetings. Once statements were confirmed, supportive text was finalized, and an anonymous vote was completed using Research Electronic Data Capture to record consensus. SETTING: An international expert panel comprising colorectal surgeons who perform ventral rectopexy in a high-volume center. MAIN OUTCOME MEASURES: Statements and associated expert consensus. RESULTS: Eleven experts identified 10 domains for review: indications, contraindications, assessment and planning, consent, operative details, prostheses, complications, follow-up, recurrence and reoperative surgery, and specific considerations. After round table review, there were 17 resultant statements for consideration. Experts agreed unanimously with 13 of the statements and their accompanying text, with different experts disagreeing regarding the remaining 4 statements (91% consensus each). LIMITATIONS: Paucity of high-quality data. CONCLUSIONS: This international group developed 17 statements with high consensus. These statements provide an up-to-date summary of the literature, identify key areas for research development, and provide a reference point for colon and rectal surgeons who undertake ventral rectopexy as part of their practice. See Video Abstract . RECTOPEXIA VENTRAL: CONSENSO DE UN PANEL INTERNACIONAL DE EXPERTOS Y REVISIÓN DE LA LITERATURA CONTEMPORÁNEA ANTECEDENTES: La rectopexia ventral se ha utilizado cada vez más en el tratamiento quirúrgico del prolapso rectal. Es necesario realizar una evaluación contemporánea del rol del procedimiento y una descripción de su uso en la práctica clínica. OBJETIVO: Crear un consenso internacional sobre la rectopexia ventral. DISEÑO: Un panel de expertos realizó una revisión exhaustiva de la literatura para identificar los dominios temáticos de interés. Se completaron revisiones de la literatura para cada dominio con el desarrollo de declaraciones basadas en la evidencia y la práctica. Estas fueron compiladas y revisadas por el grupo a lo largo de un total de nueve reuniones. Una vez que se confirmaron las declaraciones, se finalizó el texto de apoyo y se completó una votación anónima utilizando REDCap para registrar el consenso. ESCENARIO: Un panel internacional de expertos compuesto por cirujanos colorrectales que realizan rectopexia ventral en un centro de alto volumen. PRINCIPALES MEDIDAS DE RESULTADOS: Declaraciones y consenso de expertos asociado. RESULTADOS: Once expertos identificaron diez dominios a revisar: indicaciones, contraindicaciones, evaluación y planificación, consentimiento, detalles operatorios, prótesis, complicaciones, seguimiento, recurrencia y cirugía reoperatoria y consideraciones específicas. Después de la revisión en mesa redonda, hubo 17 declaraciones resultantes para su consideración. Los expertos estuvieron de acuerdo unánimemente con trece de las declaraciones y su texto acompañante, y diferentes expertos estuvieron en desacuerdo con cuatro declaraciones (91% de consenso cada una). LIMITACIONES: Escasez de datos de alta calidad. CONCLUSIÓN: Este grupo internacional desarrolló 17 declaraciones con alto consenso. Estas declaraciones proporcionan un resumen actualizado de la literatura, identifican áreas claves para el desarrollo de la investigación y un punto de referencia para los cirujanos de colon y recto que realizan rectopexia ventral como parte de su práctica. (Traducción—Dr. Aurian Garcia Gonzalez )

Abstract Aim Recent evidence challenges the current standard of offering surgery to patients with ileocaecal Crohn's disease (CD) only when they present complications of the disease. The aim of this study was to compare short‐term results of patients who underwent primary ileocaecal resection for either inflammatory (luminal disease, earlier in the disease course) or complicated phenotypes, hypothesizing that the latter would be associated with worse postoperative outcomes. Method A retrospective, multicentre comparative analysis was performed including patients operated on for primary ileocaecal CD at 12 referral centres. Patients were divided into two groups according to indication of surgery for inflammatory (ICD) or complicated (CCD) phenotype. Short‐term results were compared. Results A total of 2013 patients were included, with 291 (14.5%) in the ICD group. No differences were found between the groups in time from diagnosis to surgery. CCD patients had higher rates of low body mass index, anaemia (40.9% vs. 27%, p < 0.001) and low albumin (11.3% vs. 2.6%, p < 0.001). CCD patients had longer operations, lower rates of laparoscopic approach (84.3% vs. 93.1%, p = 0.001) and higher conversion rates (9.3% vs. 1.9%, p < 0.001). CCD patients had a longer hospital stay and higher postoperative complication rates (26.1% vs. 21.3%, p = 0.083). Anastomotic leakage and reoperations were also more frequent in this group. More patients in the CCD group required an extended bowel resection (14.1% vs. 8.3%, p : 0.017). In multivariate analysis, CCD was associated with prolonged surgery (OR 3.44, p = 0.001) and the requirement for multiple intraoperative procedures (OR 8.39, p = 0.030). Conclusion Indication for surgery in patients who present with an inflammatory phenotype of CD was associated with better outcomes compared with patients operated on for complications of the disease. There was no difference between groups in time from diagnosis to surgery.