{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:23:38Z","timestamp":1786116218732,"version":"build-2736575974"},"reference-count":22,"publisher":"Royal College of Surgeons of England","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["annals"],"abstract":"\n Introduction<\/jats:title>\n This service evaluation aims to characterise variation in practice over time and outcomes of external rectal prolapse (ERP) surgery across Wales.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Patients undergoing ERP surgery between 1 January 2016 and 31 December 2020 were identified retrospectively across Welsh Health Boards. Demographic details, surgical procedure and recurrence data were obtained by the direct care team and input into a central database for analysis. The primary outcome was ERP recurrence on clinical examination. Supplementary population-level data were requested from the Patient Episode Database for Wales (PEDW) through Digital Health and Care Wales for the period 1 January 1 2016 to 31 December 2024.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 105 patients were identified; 91.4% (96 of 105) were female. The majority (93.3%, 98 of 105) underwent elective ERP surgery. Overall recurrence rate was 33.3% (35 of 105). Aggregated local trust data demonstrated a decline in national surgical volume from 37 cases in 2016 to 8 cases in 2019, with the reduction most pronounced in laparoscopic approach. The median number of cases per surgeon over 3.2 years was 2.5 (range 1\u201325), corresponding to a median annual caseload of fewer than one procedure per surgeon. Analysis of PEDW data indicated a sustained postpandemic decline in ERP surgery across Wales, with 2023\/2024 procedure rates approximately half of those recorded in 2016\/2017.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n These data suggest a significant reduction in the volume of ERP surgery performed in Wales with geographical variation. Reconfiguration of pelvic floor services in Wales may be required to ensure safe, sustainable and equitable delivery of ERP surgical care.<\/jats:p>\n <\/jats:sec>","DOI":"10.1308\/rcsann.2026.0082","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T08:29:46Z","timestamp":1786004986000},"source":"Crossref","is-referenced-by-count":0,"title":["A service evaluation of surgical interventions for external rectal prolapse in Wales"],"prefix":"10.1308","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7498-1161","authenticated-orcid":false,"given":"E","family":"Farrow","sequence":"first","affiliation":[{"name":"Cardiff and Vale University Health Board","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Silva","sequence":"additional","affiliation":[{"name":"Cardiff and Vale University Health Board","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Evans","sequence":"additional","affiliation":[{"name":"Swansea Bay University Health Board","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O","family":"Sogaolu","sequence":"additional","affiliation":[{"name":"Betsi Cadwaladr University Health Board","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Nalmpanti","sequence":"additional","affiliation":[{"name":"Royal London Hospital","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Meggy","sequence":"additional","affiliation":[{"name":"Cardiff and Vale University Health Board","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Hilton","sequence":"additional","affiliation":[{"name":"Cwm Taf Morgannwg University Health Board","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Harris","sequence":"additional","affiliation":[{"name":"Swansea Bay University Health Board","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Williams","sequence":"additional","affiliation":[{"name":"Aneurin Bevan University Health Board","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Thornton","sequence":"additional","affiliation":[{"name":"Betsi Cadwaladr University Health Board","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N","family":"Reeves","sequence":"additional","affiliation":[{"name":"Aneurin Bevan University Health Board","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Cornish","sequence":"additional","affiliation":[{"name":"Cardiff and Vale University Health Board","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"171","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"C1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.12177"},{"key":"C2","doi-asserted-by":"crossref","first-page":"e000198","DOI":"10.1136\/bmjsit-2023-000198","volume":"5","author":"Kelley JK","year":"2023","journal-title":"BMJ Surg Interv Health Technol"},{"key":"C3","doi-asserted-by":"publisher","DOI":"10.1111\/codi.15094"},{"key":"C4","doi-asserted-by":"publisher","DOI":"10.1155\/2011\/974573"},{"key":"C5","unstructured":"Department of Health and Social Care. Independent Medicines and Medical Devices Safety Review: Update Report on Government Implementation. https:\/\/www.gov.uk\/government\/publications\/independent-medicines-and-medical-devices-safety-review-update-report-on-government-implementation\/independent-medicines-and-medical-devices-safety-review-update-report-on-government-implementation (cited January 2026)."},{"key":"C6","unstructured":"National Institute for Health and Care Excellence (NICE). Laparoscopic Ventral Mesh Rectopexy for Internal Rectal Prolapse. www.nice.org.uk\/guidance\/htg475 (cited February 2026)."},{"key":"C7","doi-asserted-by":"publisher","DOI":"10.1093\/bjs\/znae046.019"},{"key":"C8","unstructured":"Office for National Statistics. Population Estimates for the UK, England, Wales, Scotland and Northern Ireland https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/populationandmigration\/populationestimates\/bulletins\/annualmidyearpopulationestimates\/mid2024 (cited January 2026)."},{"key":"C9","unstructured":"The Pelvic Floor Society. Accreditation of Units. https:\/\/thepelvicfloorsociety.org.uk\/patients\/find-a-tpfs-accredited-unit-in-the-uk.aspx (cited July 2026)."},{"key":"C10","volume-title":"Is access to surgery a postcode lottery?","author":"Royal College of Surgeons of England","year":"2014"},{"key":"C11","first-page":"24","volume":"7","author":"Hammond K","year":"2007","journal-title":"Ochsner J"},{"key":"C12","doi-asserted-by":"publisher","DOI":"10.1177\/17455057251399009"},{"key":"C13","doi-asserted-by":"publisher","DOI":"10.31389\/lseppr.122"},{"key":"C14","unstructured":"Llywodraeth Cymru Welsh Government. The Health and Social Care (Quality and Engagement) (Wales) Act: Summary. https:\/\/www.gov.wales\/health-and-social-care-quality-and-engagement-wales-act-summary-html (cited January 2026)."},{"key":"C15","unstructured":"Llywodraeth Cymru Welsh Government. Women\u2019s Health Plan for Wales Launched to Close the Gender Health Gap. https:\/\/www.gov.wales\/womens-health-plan-wales-launched-close-gender-health-gap (cited January 2026)."},{"key":"C16","unstructured":"NHS England. Outcomes and Registries Programme. https:\/\/www.england.nhs.uk\/outcomes-and-registries-programme\/ (cited February 2026)."},{"key":"C17","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000001023"},{"key":"C18","volume":"2012","author":"Archampong D","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"C19","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa012337"},{"key":"C20","unstructured":"Llywodraeth Cymru Welsh Government. The Duty of Quality Statutory Guidance 2023 and Health and Care Quality Standards 2023. https:\/\/www.gov.wales\/sites\/default\/files\/publications\/2023-03\/duty-of-quality-statutory-guidance.pdf (cited January 2026)."},{"key":"C21","unstructured":"Pelvic Floor Report. Practical Recommendations to Address Inequalities in Care for Patients with Pelvic Floor Disorders and to Improve Services for the Future. https:\/\/www.pelvicfloorreport.com\/ (cited July 2026)."},{"key":"C22","unstructured":"Lund J, Cook T, ISCP. Chairs of the Specialty Advisory Committee for General Surgery. https:\/\/www.iscp.ac.uk\/media\/1103\/general-surgery-curriculum-aug-2021-approved-oct-20v3.pdf (cited January 2026)."}],"container-title":["The Annals of The Royal College of Surgeons of England"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publishing.rcseng.ac.uk\/doi\/pdf\/10.1308\/rcsann.2026.0082","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T08:29:53Z","timestamp":1786004993000},"score":1,"resource":{"primary":{"URL":"https:\/\/publishing.rcseng.ac.uk\/doi\/10.1308\/rcsann.2026.0082"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,6]]},"references-count":22,"alternative-id":["10.1308\/rcsann.2026.0082"],"URL":"https:\/\/doi.org\/10.1308\/rcsann.2026.0082","relation":{},"ISSN":["0035-8843","1478-7083"],"issn-type":[{"value":"0035-8843","type":"print"},{"value":"1478-7083","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,6]]},"article-number":"rcsann.2026.0082"}}