Published online Jan 21, 2022. doi: 10.12998/wjcc.v10.i3.891
Peer-review started: March 10, 2021
First decision: October 20, 2021
Revised: November 8, 2021
Accepted: December 21, 2021
Article in press: December 21, 2021
Published online: January 21, 2022
Laparoscopic ventral mesh rectopexy (LVMR) has over the past years become the preferred treatment for full thickness rectal prolapse, rectoceles, enteroceles and symptomatic rectal intussusception in many colorectal surgical centres around the world.
Over the last few years there have been concerns about the usage of meshes in pelvic surgery, especially since serious complications have been recorded in urogynaecology procedures.
To show that the incidence of mesh-related complications, and particularly mesh erosion, after LVMRs is low, especially when a biological mesh is used. We also wanted to investigate whether there is a significant improvement in function and quality of life outcomes.
Questionnaires for the calculation of Wexner scores for constipation and incontinence were completed by 86 patients who underwent LVMR with Permacol (Biological) mesh from 2012 to 2018 at University Hospital Wishaw. The patients were followed up in the clinic 12 mo after surgery. Statistical analysis of the result included the calculation of median and interquartile range (IQR) values and comparison and analysis between pre-operative and post-operative values. Complication and recurrence rates were evaluated and analysed using the Kaplan-Meier method.
The median Wexner scores for constipation pre-operatively and post-operatively were 14.5 (IQR 10.5-18.5) and 3 (IQR: 1-6), respectively, while the median Wexner score for faecal incontinence was 11 (IQR: 7-15) and 2 (IQR: 0-5), respectively (P < 0.01). There were 4 (4.6%) recurrences, 2 cases with erosion of a suture through the rectum and 1 patient that returned with diskitis. There were no mesh complications or mortalities.
In our results, it is demonstrated that LVMR using a biological mesh is both safe and effective for the treatment of rectal prolapse and that it fundamentally improves bowel symptoms of obstructive defecation and faecal incontinence in patients with internal rectal prolapse and symptomatic rectoceles.
Since we acknowledge that the direct follow-up period was short, we will continue our efforts to follow up our patients and formally assess their quality of life again in the near future.