The international variability of surgery for rectal prolapse

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Surgical Education

Background:

• Rectal prolapse is a condition with no universally agreed-upon optimal treatment.
• Understanding current surgical practices is crucial for identifying areas for improvement and education.

Purpose of the Study:

• To assess international patterns in the diagnosis and surgical management of full-thickness rectal prolapse.
• To identify variations in preoperative evaluation and surgical approach among colorectal surgeons.

Main Methods:

• An international survey with 249 colorectal surgeons was conducted.
• The survey covered surgeon demographics, preoperative workup, and procedural preferences for rectal prolapse.
• Data were analyzed to identify trends and variations based on patient characteristics and geographic location.

Main Results:

• Significant variability exists in preoperative evaluation, with only 19% routinely using anorectal physiology testing.
• Minimally invasive abdominal approaches are preferred for healthy patients, with ventral rectopexy being the most common (56%).
• Surgical technique preferences (e.g., mesh vs. biologic grafts, Delormes vs. Altmeier) varied significantly by geographic region.

Conclusions:

• There is considerable international divergence in the management of rectal prolapse.
• The lack of consensus highlights a need for further research and standardized educational initiatives for surgeons.
• Most surveyed surgeons expressed a desire for additional education on surgical approaches to rectal prolapse.