SP 8.14 Decisional Regret in Rectal Prolapse Surgery: A Single Centre 10-Year Experience with Ventral Mesh Rectopexy

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Abstract Aims Ventral mesh rectopexy (VMR) is a widely accepted technique for the repair of full-thickness rectal prolapse (FTRP) and increasingly favoured over the perineal approach given the low risk of complications and recurrence rate. However, there is limited data on patient-reported decision regret. Therefore, this study aims to identify predictors of decisional regret among patients undergoing VMR for FTRP. Methods This single-centre retrospective cohort study included patients who underwent VMR for clinically or radiologically confirmed FTRP between January 2014 and February 2025 at a tertiary pelvic floor unit. Demographic and baseline clinical data were extracted from electronic health records. Decisional regret was measured using the Ottawa Decision Regret Scale (ODRS). Results Eighty patients were analysed, of whom 75 (93.7%) were female and 23 (28.8%) were aged ≥70 years. Median follow-up was 42.5 months (range 6–140). Overall, 49 (61.3%) reported no regret, 17 (21.3%) mild regret, and 14 (17.5%) moderate-severe regret. Patients aged ≥70 years were significantly less likely to experience regret than younger patients (21.7% vs 45.6%, p=0.047). Although 36% reported recurrence, only 15% had confirmed recurrence on follow-up. Both patient-reported and true recurrence were strongly associated with higher regret (p <0.0001 and p=0.005, respectively). Psychiatric comorbidity, rectocele, perineal descent, postoperative faecal incontinence, and obstructive defaecation syndrome showed no association with regret. Conclusions Younger age, recurrence, and perceived recurrence were key predictors of decisional regret following VMR for FTRP. Further prospective work is required to understand the underlying reasons for regret and to optimise preoperative counselling.

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