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Life after PROSPER. What do people do for external rectal prolapse?
C K Gunner1, A Senapati2, J M A Northover3
1Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Summary
Surgical practices for external rectal prolapse have evolved. Surgeons increasingly favor laparoscopic abdominal approaches, while perineal procedures, though still used for specific patient groups, have seen a decline in overall preference.
Area of Science:
- Colorectal Surgery
- Surgical Practice Evolution
- Rectal Prolapse Management
Background:
- A 1997 questionnaire revealed significant practice variations among Association of Coloproctology of Great Britain and Ireland (ACPGBI) members regarding external rectal prolapse surgery.
- The PROSPER trial aimed to address these variations, and its publication marked a point for re-evaluation of surgical trends.
Purpose of the Study:
- To assess changes in surgical management practices for external rectal prolapse since 1997.
- To compare current surgical preferences with those documented before the PROSPER trial.
Main Methods:
- An online survey was distributed to all ACPGBI members.
- The survey utilized identical questions to a 1997 questionnaire to ensure comparability.
- Response rates were compared between the 1997 and 2014 surveys.
Main Results:
- Surgeons favoring an abdominal approach for fit patients significantly increased from 63.5% in 1997 to 81.7% in 2014.
- Ventral rectopexy became the preferred abdominal approach (48.6% in 2014), with high laparoscopic utilization (96.3%).
- While Delorme's remained popular, Altemeier procedure use increased, and posterior and resection rectopexy decreased significantly.
Conclusions:
- Surgical management of external rectal prolapse has demonstrably shifted towards laparoscopic abdominal techniques.
- Perineal approaches, though less favored overall, maintain their role in specific patient populations.
- The data indicates a significant evolution in surgical strategy for rectal prolapse over nearly two decades.
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