LAUSR

t t r r c p Although multiple operations have been described for the surgical treatment of rectal prolapse over the past 150 years, there have been very few trials conducted to compare treatments and even fewer to compare the functional outcomes. One of the largest randomised trials conducted in the field of pelvic floor surgery is the well-known PROSPER trial comparing abdominal with perineal approaches. [1] Although there was a clear trend in favour of resection rectopexy with a recurrence rate of 13% (suture rectopexy 26%, perineal rectosigmoidectomy 24%, Delorme’s 31%) there was no significant differences declared in the randomised comparisons although substantial improvements in the quality of life were noted following all procedures. However, only 293 of the original target 950 patients were recruited when the trial was stopped. As such it is not appropriate to consider this to be evidence of equivalence between abdominal and perineal approaches for treatment of rectal prolapse. Ventral rectopexy was not included as one of the choices in the PROSPER trial as it had not been widely performed at the time that the trial was commenced, even though it had been performed by small groups in Europe since the 1950 ′ s/1960 ′ s. Indeed, the term “ventral rectopexy” was first used in a paper by the German Surgeon F. Deuscher in 1960. [2] A number of centres in Europe and the United Kingdom started performing the modern interpretation of the ventral rectopexy using minimally invasive approaches. [3] The principle advantage of the ventral approach is the avoidance of the posterior mobilisation and preservation of rectal function with avoidance of postoperative constipation. In a follow up to the PROSPER trial, which examined the surgical practices for exter-