Ventral mesh rectopexy: Variations in technique and care process. A multicentre study

Abstract

AimThe aim of this improvement collaborative is to explore the variation in care within and between Flemish hospitals in preoperative assessment, surgical indications, perioperative management and surgical technique for ventral mesh rectopexy (VMR).MethodThis observational, cross-sectional multicentre study was performed in 14 Flemish hospitals. Twenty consecutive patients per hospital undergoing primary VMR in 2022 were included. Quality of care was assessed via predefined perioperative disease-specific quality indicators (QIs) by means of structured questionnaires. Data were collected from electronic patient files.ResultsA total of 280 patients were included. All patients were female and their mean age was 62 +/- 14 years. Significant intra- and interhospital variation was observed in preoperative work-up, indications, operative technique and postoperative management. Total rectal prolapse was the indication for VMR in only 17.5% of the patients. The surgical approach was minimally invasive in all cases, with 40% via a robotic and 60% a laparoscopic approach. Fifteen per cent of patients had mechanical bowel preparation. All centres used a synthetic polypropylene mesh to perform a VMR, and in 85.6% (n = 238) of all patients a lightweight mesh was used. Diverging practices were noted as to type of mesh fixation to the rectum. In one third of patients a nonresorbable suture was combined with biological glue (n = 89, 31.8%). The overall mean length of stay was 2.1 (+/- 2.7) days. Only 3% of the procedures were performed as same day discharge, 47% of the patients remained for 1 day and 50% for >= 2 days. Only four patients were readmitted within 30 days after surgery.ConclusionThis study shows a significant variation in the perioperative management and surgical technique for VMR between hospitals, ongoing controversies and a lack of standardization. This collaborative can serve as a structured feedback tool to define minimum QIs and minimum outcome reporting parameters. Consensus building and adherence to evidence-based guidelines should reduce variation in care processes and lead to improved patient outcomes.