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Published on: July 27, 2017
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Ventral mesh rectopexy: Variations in technique and care process. A multicentre study.
Ellen Coeckelberghs1, Ahmed M Chaoui2, Mohamed Abasbassi3
1Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Leuven, Belgium.
Summary
This study found significant variation in ventral mesh rectopexy (VMR) care across Flemish hospitals, highlighting a need for standardization. Improving VMR practices through evidence-based guidelines can enhance patient outcomes.
Area of Science:
- Colorectal Surgery
- Surgical Quality Improvement
- Health Services Research
Background:
- Ventral mesh rectopexy (VMR) is a surgical procedure for rectal prolapse and related conditions.
- There is a recognized need to assess and improve the quality of care in VMR procedures.
- Understanding variations in current practice is crucial for developing standardized protocols.
Purpose of the Study:
- To investigate variations in preoperative assessment, surgical indications, perioperative management, and surgical techniques for VMR within and between Flemish hospitals.
- To identify areas of inconsistency in VMR care delivery.
- To establish a baseline for quality improvement initiatives in VMR.
Main Methods:
- An observational, cross-sectional, multicentre study involving 14 Flemish hospitals.
- Inclusion of 20 consecutive patients per hospital who underwent primary VMR in 2022.
- Assessment of quality of care using predefined, disease-specific quality indicators (QIs) via structured questionnaires and electronic patient file data.
Main Results:
- A total of 280 female patients (mean age 62 years) were analyzed.
- Significant intra- and interhospital variations were observed in all aspects of VMR care, from preoperative work-up to postoperative management.
- While all procedures were minimally invasive (robotic or laparoscopic), practices varied in bowel preparation, mesh type (predominantly lightweight polypropylene), mesh fixation, and length of hospital stay (mean 2.1 days).
Conclusions:
- Significant variation exists in the perioperative management and surgical techniques for VMR among Flemish hospitals, indicating a lack of standardization and ongoing controversies.
- This collaborative initiative can serve as a feedback tool to define minimum quality indicators and outcome reporting parameters.
- Building consensus and adhering to evidence-based guidelines are essential to reduce practice variations and improve patient outcomes in VMR.
