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) continues to be a popular treatment option for rectal prolapse, obstructive defecation/faecal incontinence and rectoceles. In recent years there have been concerns regarding the safety of mesh placements in the pelvis.
To assess the safety of the mesh and the outcome of the procedure.
Eighty-six patients underwent LVMR with Permacol (Biological) mesh from 2012 to 2018 at University Hospital Wishaw. Forty were treated for obstructive defecation secondary to prolapse, rectocele or internal rectal intussusception, 38 for mixed symptoms obstructive defecation and incontinence, 5 for pain and bleeding secondary to full thickness prolapse and 3 with symptoms of incontinence. Questionnaires for the calculation of Wexner scores for constipation and incontinence were completed by the patients who were followed up in the clinic 12 wk after surgery and again in 6-12 mo. The average review of their notes was 18.3 ± 4.2 mo.
The median Wexner scores for constipation pre-operatively and post-operatively were 14.5 [Interquartile range (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 that presented with erosion of a suture through the rectum and one with diskitis. No mesh complications or mortalities were recorded.
LVMR using a Permacol mesh is a safe and effective procedure for the treatment of obstructive defecation/faecal incontinence, rectal prolapse, rectoceles and internal rectal prolapse/intussusception.
Core Tip: Our study adds more evidence to support that laparoscopic mesh rectopexies using biological mesh is a safe and effective procedure and that it significantly improves bowel symptoms of obstructive defecation and faecal incontinence in patients. In our study, there were no mesh related complications, and the recurrence rates were in line with the ones reported in the literature. Although we acknowledge that the direct follow-up period was short, the absence of re-referral of those previously operated patients over the period of 5 years indirectly suggests the safety of the mesh over longer periods.