Recurrence rates after abdominal surgery for complete rectal prolapse: a multicenter pooled analysis of 643 individual patient data.

PURPOSE: This study was designed to determine what impact surgical technique, means of access, and method of rectopexy have on recurrence rates following abdominal surgery for full-thickness rectal prolapse. METHODS: Consecutive individual patient data on age, gender, surgical technique (mobilization-only, mobilization-resection-pexy, or mobilization-pexy), means of access (open or laparoscopic), rectopexy method (suture or mesh), follow-up length, and recurrences were collected from 15 centers performing abdominal surgery for full-thickness rectal prolapse between 1979 and 2001. Recurrence was defined as the presence of full-thickness rectal prolapse after abdominal surgery. Chi-squared test and Cox proportional hazards regression analysis were used to assess statistical heterogeneity. Recurrence-free curves were generated and compared using the Kaplan-Meier method and log-rank test, respectively. RESULTS: Abdominal surgery consisted of mobilization-only (n = 46), mobilization-resection-pexy (n = 130), or mobilization-pexy (n = 467). There were 643 patients. After excluding center 8, there was homogeneity on recurrence rates among the centers with recurrences (n = 8) for age (hazards ratio, 0.6; 95 percent confidence interval, 0.2-1.7; P = 0.405), gender (hazards ratio, 0.6; 95 percent confidence interval, 0.1-2.3; P = 0.519), and center (hazards ratio, 0.3; 95 percent confidence interval, 0.1-1.5; P = 0.142). However, there was heterogeneity between centers with (n = 8) and without recurrences (n = 6) for gender (P = 0.0003), surgical technique (P \u3c 0.0001), means of access (P = 0.01), and rectopexy method (P \u3c 0.0001). The median length of follow-up of individual centers varied from 4 to 127 months (P \u3c 0.0001). There were 38 recurrences at a median follow-up of 43 (range, 1-235) months. The pooled one-, five-, and ten-year recurrence rates were 1.06, 6.61, and 28.9 percent, respectively. Age, gender, surgical technique, means of access, and rectopexy method had no impact on recurrence rates. CONCLUSIONS: Although this study is likely underpowered, the impact of mobilization-only on recurrence rates was similar to that of other surgical techniques

Overlay of (<i>R</i>)-mandelate and (<i>S</i>)-mandelate ligands docked into the <i>S. coelicolor</i> Hms model in silico.

<p>The (<i>S</i>)-mandelate (green) coordinated structure showed a slightly distorted trigonal bipyramidal geometry that mirrors crystal structural data of the <i>A. orientalis</i> HMS product complex (PDB: 2R5V) with angle deviations <2°. In the (<i>R</i>)-mandelate (red) bound model, the positions of the axial ligands, namely the carboxylate oxygen from Glu340 and the hydroxy oxygen from mandelate, were preserved. However, the residues that form the trigonal plane showed major deviations from ‘ideal’ geometry: Angles between the coordinated (<i>R</i>)-mandelate’s carboxylate oxygen, the iron cofactor and the histidines’ metal-nitrogens shifted from 110° to 139° (His 181) and from 124° to 100° (His261), respectively.</p

Preparation of α-oxo acids VII, VIII, and IX from the corresponding aromatic aldehydes.

<p>Preparation of α-oxo acids VII, VIII, and IX from the corresponding aromatic aldehydes.</p

Specific activity of <i>S. coelicolor</i> Hms for a range of aliphatic 2-oxo acids and corresponding calculated substrate log <i>D</i> values.

<p>Measurements were performed in air saturated 20 mM Tris buffer at pH 7.5 and 25°C. Values for HPP are given in comparison. The limit of detection under assay conditions was a specific rate of 10⁻⁵ s⁻¹.</p

Steady state kinetic constants of <i>S. coelicolor</i> Hms for a range of aromatic 2-oxo acids and corresponding product enantiopurity.

<p>Apparent kinetic constants were determined at air saturation (20 mM Tris buffer, pH 7.5, 25°C).</p>*<p>The analytical method did not allow a more precise determination.</p

Substrate and product ligands docked into the <i>S. coelicolor</i> Hms model in silico.

<p>Several active site residues are omitted for clarity. Column 1 shows HPP (white) and (<i>S</i>)-<i>p</i>-hydroxymandelate (black), column 2 gives PP (apricot) and (<i>S</i>)-mandelate (light pink), column 3 depicts <i>p</i>-methoxy-PP (teal) and (<i>S</i>)-<i>p</i>-methoxymandelate (purple) and column 4 displays 2-oxo-4-phenylbutanoic acid (pink) and (<i>S</i>)-4-phenyllactate (light blue). Indicated distances are summarized in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0068932#pone.0068932.s012" target="_blank">Table S5</a>.</p

Principle proposed reaction mechanism of Hms [5].

<p>Principle proposed reaction mechanism of Hms <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0068932#pone.0068932-Shah1" target="_blank">[5]</a>.</p