EP877 - What Does Success Look Like in Rectal Prolapse Surgery?

Purpose/Background: Traditionally, studies on full-thickness rectal prolapse (FTRP) surgery define success as anatomical correction of rectal evisceration (RE) and improvement in constipation (C) or fecal incontinence (FI), while avoiding de novo symptoms. However, patients often describe a broader range of concerns. This study evaluated whether conventional patient-reported outcome (PRO) metrics used in FTRP research align with patients' personal goals and expectations for surgery.

Methods/Interventions: The RECOGNIZE study is a prospective, multi-center investigation of FTRP patients undergoing robotic abdominal repairs at five U.S. and U.K. hospitals (8/2024-8/2025). Sixty -three consecutive patients completed the Measure Yourself Medical Outcome Profile (MYMOP-2) in addition to standard PRO instruments commonly reported in the FTRP literature (table).The MYMOP-2 allowed patients to identify two personally important symptoms and one limitation they hoped would improve postoperatively. These were thematically grouped into domains and compared with standard PROs for alignment. Patients were stratified by perceived symptoms and limitations severity (MYMOP >15 vs. ≤15). Correlations between MYMOP scores and other PROMs were assessed using Pearson's correlation coefficient (p < 0.05).

Results/Outcomes: Sixty-three female patients (mean age 69.3 ± 14.5 years; mean Charlson Comorbidity Index 3.6 ± 3.3) identified 126 unique symptoms and 63 activities they hoped to improve with surgery. Beyond RE, FI, and C, patients frequently cited additional domains (Figure). Cumulative MYMOP scores (range 3-18), reflected a severity in these symptoms and limitations (mean 15.0 ± 1.1; median 15.0 [IQR 14.0-18.0]). Patients with higher MYMOP scores also had statistically worse QOL (EQ-5D, PAC-QOL, FI-QOL, PFIQ-7) ; FI (Wexner, Vaisey) and vaginal prolapse (CRADI, POPDI, UDI) symptoms, but the correlations with these commonly used pelvic floor PRO measurements was - at best - moderate. Interestingly, constipation severity scores (PAC-SYM and CSI ) showed no correlation with rectal prolapse-specific perceptions of disease severity (MYMOP-2)scores (Table).

Conclusion/Discussion: FTRP patients report a wide spectrum of symptoms and consequences extending beyond constipation, FI, or RE. Conventional scoring systems underestimate this cumulative burden by failing to capture these broader patient-defined concerns. Reliance on constipation-specific scores may be misleading, given their poor correlation with MYMOP results. Future studies should incorporate patient-identified outcomes and may require the development and validation of an FTRP-specific severity instrument to enable higher-quality research.

Figure 1. a.Symptoms and Consequences Reported by Patients with Rectal Prolapse ; b. Correlation of MYMOP -2 to other PROs