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A UK-based multicenter randomized controlled trial was designed to determine the clinical efficacy of LVMR compared to controls at medium-term follow-up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The randomized controlled trial was conducted from March 1, 2015 TO January 31, 2019. A stepped-wedge RCT design permitted observer-masked data comparisons between patients awaiting LVMR (controls) with those who had undergone surgery. Adult participants with radiologically confirmed IRP refractory to conservative treatment were randomized to three arms with different delays before surgery. Efficacy outcome data were collected at equally stepped time points (12, 24, 36, 48, 60, and 72\u00a0weeks). Clinical efficacy of LVMR compared to controls was defined as\u2009\u2265\u20091.0-point reduction in Patient Assessment of Constipation-Quality of Life and\/or Symptoms (PAC-QOL and\/or PAC-SYM) scores at 24\u00a0weeks. Secondary outcome measures included 14-day diary data, the Generalized Anxiety Disorder scale (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), St Marks incontinence score, the Pelvic Organ Prolapse\/Urinary Incontinence Sexual Questionnaire (PISQ-12), the chronic constipation Behavioral Response to Illness Questionnaire (CC-BRQ), and the Brief Illness Perception Questionnaire (BIPQ).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of a calculated sample size of 114, only 28 patients (100% female) were randomized from 6 institutions (due mainly to national pause on mesh-related surgery). Nine were assigned to the T0 arm, 10 to T12, and 9 to T24. There were no substantial differences in baseline characteristics between the three arms. Compared to baseline, significant reduction (improvement) in PAC-QOL and PAC-SYM scores were observed at 24\u00a0weeks post-surgery (\u2013\u00a01.09 [95% CI \u2013\u00a01.76, \u2013\u00a00.41],<jats:italic>p<\/jats:italic>\u2009=\u20090.0019, and \u2013\u00a00.92 [\u2013\u00a01.52, \u2013\u00a00.32],<jats:italic>p<\/jats:italic>\u2009=\u20090.0029, respectively) in the 19 patients available for analysis (9 were excluded for dropout [<jats:italic>n<\/jats:italic>\u2009=\u20092] or missing primary outcome [<jats:italic>n<\/jats:italic>\u2009=\u20097]). There was a clinically significant long-term reduction in PAC-QOL scores (\u2212\u00a01.38 [\u2212\u00a02.94, 0.19],<jats:italic>p<\/jats:italic>\u2009=\u20090.0840 at 72\u00a0weeks). Statistically significant improvements in PAC-SYM scores persisted to 72\u00a0weeks (\u2212\u00a01.51 [\u2212\u00a02.87, \u2212\u00a00.16],<jats:italic>p<\/jats:italic>\u2009=\u20090.0289). Compared to baseline, no differences were found in secondary outcomes, except for significant improvements at 24 and 48\u00a0weeks on CC-BRQ avoidance behavior (\u2212\u00a014.3 [95% CI \u2212\u00a023.3, \u2212\u00a05.4], and \u2212\u00a00.92 [\u2212\u00a01.52, \u2212\u00a00.32], respectively), CC-BRQ safety behavior (\u2212\u00a013.7 [95% CI \u2212\u00a020.5, \u2212\u00a07.0], and \u2212\u00a013.0 [\u2212\u00a019.8, \u2212\u00a06.1], respectively), and BIPQ negative perceptions (\u2212\u00a016.3 [95% CI \u2212\u00a023.5, \u2212\u00a09.0], and \u2212\u00a010.5 [\u2212\u00a017.9, \u2212\u00a03.2], respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>With the caveat of under-powering due to poor recruitment, the study presents the first randomized trial evidence of short-term benefit of LVMR for internal rectal prolapse.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration<\/jats:title><jats:p>ISRCTN Registry (ISRCTN11747152).<\/jats:p><\/jats:sec>","DOI":"10.1007\/s10151-022-02633-w","type":"journal-article","created":{"date-parts":[[2022,5,19]],"date-time":"2022-05-19T10:03:56Z","timestamp":1652954636000},"page":"941-952","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Stepped-wedge randomized controlled trial of laparoscopic ventral mesh rectopexy in adults with chronic constipation"],"prefix":"10.1007","volume":"26","clinical-trial-number":[{"clinical-trial-number":"isrctn1174715","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5372-2873","authenticated-orcid":false,"given":"U.","family":"Grossi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Lacy-Colson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. 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Charles H Knowles was a paid consultant to Medtronic plc (Dublin, Ireland) during the course of the programme (but on an unrelated research area) and received consulting fees from EnteroMed Ltd (London, UK) and Coloplast A\/S (Humleb\u00e6k, Denmark). He has received payment or honoraria from Medtronic plc and support for attending meetings\/travel from Medtronic plc. He is chairperson of the European Society of Coloproctology Research Committee and the Bowel Research UK (London, UK) Grants Committee. Jon Lacy-Colson was a paid consultant to Origin Sciences Ltd (Cambridge, UK) during the course of the programme (but on an unrelated research area). S Mark Scott received honoraria from Laborie (Orangeburg, NY, USA) for teaching during the course of (but unrelated to) the programme. Christine Norton is chief investigator on another programme grant on symptom management in inflammatory bowel disease.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}