Surgeon preferences and practice patterns in rectopexy: Results of an international survey

TL;DR

This study surveyed surgeons globally to understand variations in rectopexy techniques for rectal prolapse, finding significant differences influenced by personal and regional preferences.

Contribution

The paper provides the first international survey on rectopexy practices, highlighting variability and the need for updated guidelines.

Findings

Most surgeons use minimally invasive approaches, with laparoscopy being the most common.

There is significant regional variation in dissection techniques and mesh usage.

Only a small percentage perform rectopexy as a day-case procedure.

Abstract

Rectopexy is the preferred abdominal intervention for rectal prolapse. Despite similar procedural steps – rectal mobilisation, prolapse reduction, and fixation – techniques vary widely, and onsensus on the optimal approach is lacking. This study aimed to assess global surgeon preferences and practices in rectopexy.

An international 28‐item online survey was distributed between November 2023 and March 2024 through professional networks and social media. Questions addressed surgeon demographics, perioperative strategies, and technical approaches to rectopexy. Responses were analysed descriptively and stratified by region and specialty.

A total of 226 surgeons from 36 countries across four continents completed the survey. Most respondents (79.6%) administered preoperative intravenous antibiotics, and 80.5% used some form of mechanical bowel preparation. Minimally invasive approaches predominated (81%), with laparoscopy being most common. Posterior dissection was preferred by 61.5%, while 38.5% favoured ventral (anterior) dissection. Two‐thirds (68.1%) routinely used mesh, predominantly synthetic. Only 15% performed rectopexy as a day‐case procedure. Regional and specialty‐related variations were evident in approach, mesh type, and perioperative protocols.

This international survey reveals marked variability in rectopexy practice worldwide. Despite common principles, surgeon preference and regional factors strongly influence decision‐making. The findings emphasise the need for updated international guidelines to harmonise technique selection and perioperative management in rectal prolapse surgery.

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