Rectal prolapse: tailoring operative strategy to pathophysiology

Surgery for rectal prolapse has long been shaped as much by the heterogeneity of methods and measurements as by true differences between operations.A recent multicenter audit of ventral mesh rectopexy (VMR) demonstrated striking interhospital variation in indication, operative steps, fixation, and peri-operative pathways, underlining how inconsistent reporting and follow-up dilute any comparative inference [1].Against this background, the two recent Controversies in Coloproctology papers, one advocating VMR and the other defending resection rectopexy (RR), should be read less as opposing manifestos than as complementary calls for phenotype-driven, standardized surgery [2,3].