PWE-381 Life after prosper: a review of the management of rectal prolapse

Abstract

<h3>Introduction</h3> 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. <h3>Method</h3> A 10 question online survey was circulated to all members of the ACPGBI with identical questions to those used in the original in 2000. <h3>Results</h3> 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 &lt; 0.01)) while those favouring a posterior rectopexy has decreased dramatically 45% vs. 92.6% (p &lt; 0.01). Only 5.4% still favour resection rectopexy compared to 39.7% previously (p &lt; 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 &lt; 0.01). <h3>Conclusion</h3> 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. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Senapati A, Gray RG, Middleton LJ <i>et al</i>. PROSPER: a randomised comparison of surgical treatments for rectal prolapse. <i>Colorectal Dis</i>. 2013 Jul;15(7):858–68