Long-term outcomes after ventral mesh rectopexy for rectal prolapse: a 12-year single-centre experience

Introduction Ventral mesh rectopexy (VMR) is an established treatment for rectal prolapse with favourable functional outcomes. However, long-term real-world data beyond 5 years on recurrence and mesh-related complications remain limited. This study evaluates long-term recurrence, short-term morbidity, mesh-related complications, and outcomes after laparoscopic and robotic VMR. Methods A retrospective single-centre cohort study was conducted including all consecutive patients who underwent VMR for rectal prolapse at a tertiary centre between 2012 and 2023, with a median follow-up of 69 months (range 12–143). Demographic, clinical, operative, and follow-up data were analysed. Recurrence, defined as clinical or radiological evidence of prolapse, and postoperative complications classified using the Clavien–Dindo system, including mesh-related events, were assessed, with outcomes stratified by mesh type and surgical approach. Results Among 208 patients (median age 64 years; 92% female), 95% were completed minimally invasively (43% laparoscopic and 52% robotic). Overall, recurrence occurred in 38 patients (18.3%), with a median time to recurrence of 41 months. In an unadjusted comparison, recurrence was recorded in 27.0% (24/89) after laparoscopic VMR and 11.1% (12/108) after robotic VMR (chi-square p = 0.004). Because robotic surgery and synthetic mesh were adopted later, these crude proportions are confounded by calendar time, mesh selection, and unequal follow-up and should not be interpreted as comparative effectiveness estimates. Mesh-related complications were rare ( n = 1), and no 30-day mortality was observed. Conclusions VMR demonstrated acceptable long-term recurrence and a low incidence of major mesh-related complications. The observed unadjusted difference between laparoscopic and robotic approaches cannot establish procedural superiority because of temporal, mesh-selection, and follow-up confounding. Although time-to-event analysis accounted for differential follow-up, the comparisons remained unadjusted for calendar time and other confounders, precluding causal comparative inference.