Surgical decision-making for rectal prolapse: one size does not fit all

Area of Science:

• Colorectal surgery
• Surgical decision-making
• Patient-specific treatment

Background:

• Rectal prolapse treatment lacks a consensus on the optimal surgical approach.
• Over 100 abdominal and perineal procedures exist, but individual suitability varies.
• This study examines factors influencing surgical recommendations for rectal prolapse.

Purpose of the Study:

• To identify patient- and disease-related factors guiding surgical recommendations for rectal prolapse.
• To analyze treatment choices in a single surgeon's experience.
• To compare abdominal versus perineal surgical approaches.

Main Methods:

• Retrospective cohort study of 91 patients with rectal prolapse.
• Data collected on symptoms, comorbidities, exam findings, surgeon judgment, and patient preference.
• Treatment recommendations (abdominal, perineal, or no surgery) were analyzed.

Main Results:

• 93% of patients received surgical recommendations; 66% favored robotic abdominal procedures.
• Robotic ventral mesh rectopexy was the most frequent abdominal recommendation.
• Older age and anesthesia concerns correlated with perineal surgery recommendations.

Conclusions:

• Rectal prolapse treatment recommendations are surgeon-dependent and multifactorial.
• Robotic ventral mesh rectopexy was favored for selected older patients.
• Perineal procedures remain crucial for higher-risk individuals.