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Rectal prolapse is a protrusion of rectal wall through the anus. A surgical technique called Ventral mesh rectopexy has become a standard procedure for this condition in many centers.
The goal of this trial is to investigate functional outcome, recurrence rates and complications after ventral mesh rectopexy. The main question it aims to answer is:
- Do bowel function, quality of life and sexual function improve after Ventral mesh rectopexy?
Participants will:
Several different procedures have been described for surgical treatment of rectal prolapse and a consensus has not yet been reached. Over the past 20 years, the use of Ventral mesh rectopexy to treat external rectal prolapse has gained increasing worldwide acceptance. Ventral mesh rectopexy has become a standard procedure in many centers based on low recurrence rates, limited complications and good functional results but the use and type of mesh have been debated. Concerns have also been expressed regarding the choice of surgical technique, which differs between centers, and the lack of high-level evidence.
There are few prospective trials and the use of LVMR in a Swedish setting has not yet been evaluated. FOAM (Functional Outcome After ventral Mesh rectopexy) therefore aims to investigate bowel function, quality of life, sexual function, recurrence rates and complications after ventral mesh rectopexy.
A prospective cohort study on patients undergoing ventral mesh rectopexy for external rectal prolapse in Sweden will be conducted. Approximately 70 patients will be included at a maximum of 10 hospitals in Sweden.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ventral mesh rectopexy | Procedure | Ventral mesh rectopexy is performed with a superficial peritoneal incision from the right side of the sacral promontory, extended over the right outer border of the mesorectum, towards the deepest part of pouch of Douglas, sparing the right hypogastric nerve. In women, the vagina is retracted anteriorly and a dissection of the rectovaginal septum is performed down to the pelvic floor. A strip of mesh is attached to the ventral part of distal rectum and then fixed upon the sacral promontory. |
| Measure | Description | Time Frame |
|---|---|---|
| Bowel function | Wexner constipation score: scale 0-30, 30=worst outcome | Evaluated at baseline, 3-6 months and 12 months postoperatively |
| Bowel function | Wexner incontinence score: scale 0-20, 20=worst outcome | Evaluated at baseline, 3-6 months and 12 months postoperatively |
| Bowel function | Colo-rectal-anal Distress Inventory (CRADI-8): scale 0-100 (100=worst outcome) | Evaluated at baseline, 3-6 months and 12 months postoperatively |
| Quality of Life after surgery | Colorectal-Anal Impact Questionnaire (CRAIQ-7): scale 0-100, 100=worst outcome | Evaluated at baseline, 3-6 months and 12 months postoperatively |
| Sexual function | PROMIS Sexual function and satisfaction version 2.0. Selected domains: Interest in sexual activity (scale 2-10, 10=highest interest), sexual activity screener (scale yes/no) and satisfaction with sex life (scale 2-10, 10=highest satisfaction) | Evaluated at baseline, 3-6 months and 12 months postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| Recurrence rate | Recurrence of rectal prolapse | Evaluated at baseline, 3-6 months, 12 months and 3 years postoperatively. Clinical examination by surgeon will be performed to evaluate recurrence. |
| Postoperative complications |
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Inclusion Criteria:
Exclusion Criteria:
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Adults undergoing ventral mesh rectopexy for full-thickness rectal prolapse.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jannica Smedberg, MD | Contact | +46731525453 | jannica.smedberg@gotland.se |
| Name | Affiliation | Role |
|---|---|---|
| Wilhelm Graf, Professor | Department of Surgical Sciences, Uppsala Universitet | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 26599079 | Background | Tou S, Brown SR, Nelson RL. Surgery for complete (full-thickness) rectal prolapse in adults. Cochrane Database Syst Rev. 2015 Nov 24;2015(11):CD001758. doi: 10.1002/14651858.CD001758.pub3. | |
| 15499644 | Background | D'Hoore A, Cadoni R, Penninckx F. Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg. 2004 Nov;91(11):1500-5. doi: 10.1002/bjs.4779. |
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| ID | Term |
|---|---|
| D012005 | Rectal Prolapse |
| D012008 | Recurrence |
| ID | Term |
|---|---|
| D012002 | Rectal Diseases |
| D007410 | Intestinal Diseases |
| D005767 | Gastrointestinal Diseases |
| D004066 | Digestive System Diseases |
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Clavien Dindo classification
| Within 30 days postoperatively |
| Long-term complications | Ileus, pelvic abscess, mesh erosion, other complications | Evaluated at baseline, 3-6 months, 12 months and 3 years postoperatively. |
| Length of stay | Stay in hospital postoperatively | From day of operation to day of discharge from hospital, reported at follow-up 3-6 months postoperatively. |
| Mortality | 30-day mortality | Within 30 days postoperatively |
| 23384148 | Background | Badrek-Al Amoudi AH, Greenslade GL, Dixon AR. How to deal with complications after laparoscopic ventral mesh rectopexy: lessons learnt from a tertiary referral centre. Colorectal Dis. 2013 Jun;15(6):707-12. doi: 10.1111/codi.12164. |
| 26163960 | Background | Evans C, Stevenson AR, Sileri P, Mercer-Jones MA, Dixon AR, Cunningham C, Jones OM, Lindsey I. A Multicenter Collaboration to Assess the Safety of Laparoscopic Ventral Rectopexy. Dis Colon Rectum. 2015 Aug;58(8):799-807. doi: 10.1097/DCR.0000000000000402. |
| 25110205 | Background | Randall J, Smyth E, McCarthy K, Dixon AR. Outcome of laparoscopic ventral mesh rectopexy for external rectal prolapse. Colorectal Dis. 2014 Nov;16(11):914-9. doi: 10.1111/codi.12741. |
| 21306343 | Background | Teleman P, Stenzelius K, Iorizzo L, Jakobsson U. Validation of the Swedish short forms of the Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Acta Obstet Gynecol Scand. 2011 May;90(5):483-7. doi: 10.1111/j.1600-0412.2011.01085.x. |
| 37007849 | Background | Hoven E, Flynn KE, Weinfurt KP, Eriksson LE, Wettergren L. Psychometric evaluation of the Swedish version of the PROMIS Sexual Function and Satisfaction Measures in clinical and nonclinical young adult populations. Sex Med. 2023 Jan 12;11(1):qfac006. doi: 10.1093/sexmed/qfac006. eCollection 2023 Feb. |
| 33863582 | Background | Wexner SD. Further validation of the Wexner Incontinence Score: A note of appreciation and gratitude. Surgery. 2021 Jul;170(1):53-54. doi: 10.1016/j.surg.2021.02.039. Epub 2021 Apr 15. No abstract available. |
| 8646957 | Background | Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD. A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum. 1996 Jun;39(6):681-5. doi: 10.1007/BF02056950. |
| D056887 | Pelvic Organ Prolapse |
| D011391 | Prolapse |
| D020763 | Pathological Conditions, Anatomical |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |