Background: Laparoscopic ventral mesh rectopexy (LVMR) is an established treatment for external full-thickness
rectal prolapse. However, its clinical efficacy in patients with internal prolapse is uncertain due to the lack of highquality
evidence.
Methods: An individual level, stepped-wedge randomised trial has been designed to allow observer-blinded data
comparisons between patients awaiting LVMR with those who have undergone surgery. Adults with symptomatic
internal rectal prolapse, unresponsive to prior conservative management, will be eligible to participate. They will be
randomised to three arms with different delays before surgery (0, 12 and 24 weeks). Efficacy outcome data will be
collected at equally stepped time points (12, 24, 36 and 48 weeks). The primary objective is to determine clinical
efficacy of LVMR compared to controls with reduction in the Patient Assessment of Constipation Quality of Life
(PAC-QOL) at 24 weeks serving as the primary outcome. Secondary objectives are to determine: (1) the clinical
effectiveness of LVMR to 48 weeks to a maximum of 72 weeks; (2) pre-operative determinants of outcome; (3)
relevant health economics for LVMR; (4) qualitative evaluation of patient and health professional experience of
LVMR and (5) 30-day morbidity and mortality rates.
Discussion: An individual-level, stepped-wedge, randomised trial serves the purpose of providing an untreated
comparison for the active treatment group, while at the same time allowing the waiting-listed participants an
opportunity to obtain the intervention at a later date. In keeping with the basic ethical tenets of this design, the
average waiting time for LVMR (12 weeks) will be shorter than that for routine services (24 weeks).
Trial registration: ISRCTN registry, ISRCTN11747152. Registered on 30 September 2015. The trial was prospectively
registered (first patient enrolled on 21 March 2016).
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)