Nationwide Claims-Based Trends in Surgical Management of Rectal Prolapse and Rectocele in Korea, 2009–2024

Abstract Rectal prolapse and rectocele are pelvic floor disorders requiring diverse surgical approaches, but long-term nationwide trends remain poorly characterized. We analyzed de-identified Korean Health Insurance Review and Assessment Service claims from 2009 to 2024 for patients with rectal prolapse (K62.3) or rectocele (N81.6) who underwent predefined procedures. Surgical episodes were classified into rectal prolapse-only, rectocele-only, and concurrent-diagnosis cohorts; procedures were grouped as perineal, abdominal, or rectocele repair. Among 47,614 episodes, 19,663 were rectal prolapse-only, 19,431 rectocele-only, and 8,520 concurrent diagnoses. Perineal procedures accounted for 84.9% of rectal prolapse operations, whereas rectocele repair accounted for 97.3% of rectocele procedures. In the rectal prolapse cohort, abdominal procedures increased from 6.1% in 2009–2014 to 20.0% in 2020–2024. Of 4,652 abdominal procedures, 95.5% had claims for laparoscopic instrument materials. Rectocele surgery increasingly shifted toward clinics, whereas abdominal rectal prolapse procedures were concentrated in higher-level hospitals. These nationwide claims data demonstrate divergent patterns in pelvic floor surgery and increasing claims-defined laparoscopic material use among abdominal procedures for rectal prolapse in Korea.