Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 21, 2022; 10(3): 891-898
Published online Jan 21, 2022. doi: 10.12998/wjcc.v10.i3.891
Mesh safety in pelvic surgery: Our experience and outcome of biological mesh used in laparoscopic ventral mesh rectopexy
Anastasia Tsiaousidou, Linda MacDonald, Kawan Shalli
Anastasia Tsiaousidou, Linda MacDonald, Kawan Shalli, Department of Surgery, Wishaw University Hospital, Wishaw ML2 0DP, Lanarkshire, United Kingdom
Author contributions: All authors participated in examining/operating on patients, collection of data, filling of pre-operative and post-operative scoring forms, literature research, writing and editing of the script and statistical analysis of data; MacDonald L reviewed and edited the article’s language; Shalli K participated in continuous follow-up of patients and supervision of the whole project.
Institutional review board statement: No approval required for the particular study.
Conflict-of-interest statement: No conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kawan Shalli, FRCS (Gen Surg), Senior Lecturer, Department of Surgery, Wishaw University Hospital, 50 Netherton Street Wishaw, Wishaw ML2 0DP, Lanarkshire, United Kingdom. kawan.shalli@lanarkshire.scot.nhs.uk
Received: March 10, 2021
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
Processing time: 311 Days and 0.6 Hours
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.