1 Recommendations

1 Recommendations

1.1 Current evidence on the safety of laparoscopic ventral mesh rectopexy for internal rectal prolapse shows there are well‑recognised, serious but infrequent complications. The evidence on efficacy and safety is limited in quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.

1.2 Clinicians wishing to do laparoscopic ventral mesh rectopexy for internal rectal prolapse should:

  • Inform the clinical governance leads in their NHS trusts.

  • Ensure that patients understand the uncertainty about the procedure's efficacy and safety and that there are different types of mesh available, which may have different efficacies and complications. Patients should be provided with clear written information. In addition, the use of NICE's information for the public is recommended.

1.3 Patient selection should be done by a pelvic floor multidisciplinary team. This should typically include a surgeon, an urogynaecologist, a radiologist, a nurse specialist, a physiotherapist, a pelvic floor physiologist and, when appropriate, a gastroenterologist.

1.4 This procedure should only be done by surgeons who are trained and experienced in laparoscopic pelvic floor surgery, who have done their initial procedures with an experienced mentor.

1.5 Clinicians should enter details about all patients having laparoscopic ventral mesh rectopexy for internal rectal prolapse onto an appropriate registry (for example, the British Pelvic Floor Society database). The results of the registry should be published.

1.6 Clinicians are encouraged to collect data on patient selection, patient‑reported outcomes, mesh‑related complications, the type of mesh used, the attachment method and long‑term follow‑up. NICE may update the guidance on publication of further evidence.

1.7 All adverse events involving the medical devices (including the mesh) used in this procedure should be reported to the Medicines and Healthcare products Regulatory Agency.

  • National Institute for Health and Care Excellence (NICE)