Learning curves and surgical outcomes for laparoscopic ventral mesh rectopexy: Cumulative sum curve analysis

P Pucher1, A Clarke2, M Lamparelli1. 1Dorset County Hospitall, 2Poole General Hospital

Background: Laparoscopic ventral mesh rectopexy (VMR) is an effective and well recognised treatment for symptoms of obstructive defecation in the context of rectal prolapse and recto-rectal intussusception.  Uptake of the procedure has been increasing due to superior outcomes compared to traditional transanal procedures for prolapse. However, due to the technical complexity of VMR, a significant learning curve must be expected in the adoption of this procedure.  The implications on patient safety, outcomes, and resources must be considered.

Methods: A retrospective analysis of a prospectively maintained database from two district general hospitals was conducted, with inclusion of all cases performed by two surgeons since first adoption of the procedure in 2007 to the present.  Operative time, length of stay, and in-hospital complications were evaluated, with learning curves assessed using cumulative sum curves.

Results: 267 patients underwent VMR during the study period and were included for analysis.  The mean operative duration was 108 ± 31 minutes, length of stay was 1.6 ± 2.6 days.  In-hospital mortality was 2.8%, with 0% mortality.  Cumulative sum curve analysis suggested a learning curve of between 28 – 35 cases based on operative times and length of stay.  No significant learning curve was seen for morbidity or mortality. 

Conclusion: VMR is an effective and safe treatment for rectal prolapse.  Despite a moderate learning curve for operative time and length of stay, no negative effects on patient safety, morbidity, or mortality were seen.  Surgeons in this study were proctored during the adoption process by another surgeon experienced in VMR; this may contribute to increased safety and abbreviated learning curve.                

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