Introduction A questionnaire completed by members of the ACPGBI in 2000 was a precursor to the PROSPER trial. It showed a significant variation in favoured practice for the surgical treatment of rectal prolapse. We repeated the same questionnaire in 2014 to assess how practice has changed.
Method A 10 question online survey was circulated to all members of the ACPGBI with identical questions to those used in the original in 2000.
Results Similar numbers of surgeons responded (122 vs. 153). Median operations per surgeon per year is unchanged 6 (0–30) vs. 6 (0–25) and a similar proportion of surgeons have a favoured approach for fit patients (67.2% vs. 64%). More surgeons favour an abdominal approach in 2014 (55.0% vs. 40.1% (p = 0.01)). The most popular abdominal approach in 2014 is a ventral rectopexy (44.1% vs. 5.9% (p < 0.01)) while those favouring a posterior rectopexy has decreased dramatically 45% vs. 92.6% (p < 0.01). Only 5.4% still favour resection rectopexy compared to 39.7% previously (p < 0.01).
The use of perineal procedures is unchanged with 59.8% and 21.5% currently choosing Delorme’s and perineal proctectomy respectively compared to 63.4% and 14.9% in 2000. 38.5% prefer perineal approaches in elderly or unfit patients, compared with 39.2% previously and 59.8% had no age preference (61.3%).
The use of laparoscopic repair has increased dramatically with 78.7% of surgeons currently choosing this approach compared to 19% previously (p < 0.01).
Conclusion The surgical approach to management of rectal prolapse is still varied, although more surgeons now favour a laparoscopic abdominal approach. The perineal approach continues to be a favoured option particularly in elderly and unfit patients.
Disclosure of interest None Declared.
Senapati A, Gray RG, Middleton LJ et al. PROSPER: a randomised comparison of surgical treatments for rectal prolapse. Colorectal Dis. 2013 Jul;15(7):858–68
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