Problem addressed, background and strategic significance

Rectal prolapse is a distressing condition where the bowel lining prolapses outside the anal canal. Only surgery can cure the problem and surgeons have invented many operations to do this. However, no-one knows which is best. A new operation called a laparoscopic ventral mesh rectopexy seems to be the best but surgeons are worried that the results are not as good as we think and that it may be dangerous if done wrong.

Method(s) used

To try to find out which operation is best is proving difficult. Both surgeons and patients have preconceived ideas and are not willing to try other options. We have therefore come up with a trial where patients can have whatever they or the surgeon wants but we can still show which is best. This can be done by the patient simply answering regular questions about how they feel and whether the prolapse has gone. Questions are asked whilst the patient is on a waiting list and after the surgery is done. Because of the way the NHS works some people will be operated on sooner than others allowing us to compare how patients feel who have had one operation with those who have not had the operation yet or have had another type of procedure. However, there may be a snag. For the trial to be fair, people having to wait a long time for surgery should be similar to the ‘short waiters’. They may not be. For example people a long wait may be due to other health problems. Shorter waiters may be fitter. This would potentially make the study conclusions incorrect. In order to find out if there is a difference we need to do another simple questionnaire survey first essentially to prove the ‘short waiters’ and ‘long waiters’ are the same.

Hoped for results of this research

We want to do the simple trial questionnaire to help us design a bigger trial, which will tell us which is the best operation for rectal prolapse.

How will this project help build on the Delphi question and what further plans are proposed for future development?

We will eventually be able to say what is the best operation for patients with rectal prolapse and decide if this new operation (LVMR) is as good as people say it is!