A service evaluation of surgical interventions for external rectal prolapse in Wales

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INTRODUCTION: This service evaluation aims to characterise variation in practice over time and outcomes of external rectal prolapse (ERP) surgery across Wales. METHODS: Patients undergoing ERP surgery between 1 January 2016 and 31 December 2020 were identified retrospectively across Welsh Health Boards. Demographic details, surgical procedure and recurrence data were obtained by the direct care team and input into a central database for analysis. The primary outcome was ERP recurrence on clinical examination. Supplementary population-level data were requested from the Patient Episode Database for Wales (PEDW) through Digital Health and Care Wales for the period 1 January 1 2016 to 31 December 2024. RESULTS: A total of 105 patients were identified; 91.4% (96 of 105) were female. The majority (93.3%, 98 of 105) underwent elective ERP surgery. Overall recurrence rate was 33.3% (35 of 105). Aggregated local trust data demonstrated a decline in national surgical volume from 37 cases in 2016 to 8 cases in 2019, with the reduction most pronounced in laparoscopic approach. The median number of cases per surgeon over 3.2 years was 2.5 (range 1-25), corresponding to a median annual caseload of fewer than one procedure per surgeon. Analysis of PEDW data indicated a sustained postpandemic decline in ERP surgery across Wales, with 2023/2024 procedure rates approximately half of those recorded in 2016/2017. CONCLUSIONS: These data suggest a significant reduction in the volume of ERP surgery performed in Wales with geographical variation. Reconfiguration of pelvic floor services in Wales may be required to ensure safe, sustainable and equitable delivery of ERP surgical care.

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