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Case-matched series of a non-cross-linked biologic versus non-absorbable mesh in laparoscopic ventral rectopexy

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Abstract

Purpose

Laparoscopic ventral mesh rectopexy (LVR) is an emerging technique for selected patients with rectal prolapse and obstructed defaecation syndrome. Data are insufficient to conclude which type of mesh affords the greatest benefit. Our aim was to compare the outcomes of LVR using a non-cross-linked biologic versus a permanent mesh.

Methods

Twenty nine cases of LVR with permanent mesh were matched based on age and surgical indication with an equal number of patients using biologic mesh. Cases were retrospectively reviewed from a prospectively maintained database. Symptom resolution, patient satisfaction and recurrence of prolapse were measured among those who underwent LVR with either a biologic (Biodesign®, Cook Medical) or polypropylene mesh.

Results

Age, American Society of Anesthesiologists (ASA) class, surgical indication and primary symptoms were not different between the two groups. After a median follow-up of 15.4 months, all patients reported being either completely or partially satisfied. Rates of complete or partial symptom resolution (p = 0.26) or satisfaction (p = 0.27) did not differ between groups. After LVR, similar rates of additional procedures were performed in the biologic (21 %) and the permanent (28 %) mesh group. Among patients with full-thickness prolapse (n = 33), there were five cases (15 %) of recurrence, one in the biologic group and four in the permanent mesh group (p = 0.37). There were no mesh-related complications in either group.

Conclusions

LVR using a non-cross-linked biologic mesh appears to have comparable rates of symptom improvement and patient satisfaction in the short term. Longer follow-up will be required to determine if prolapse recurrence depends on mesh type.

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Conflict of interest

Dr. Stevenson is an honorary consultant for Applied Medical and Ethicon Endosurgery and has been a proctor for ventral rectopexy workshops using Biodesign from Cook Medical. Dr. Ogilvie and Dr. Powar have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Ferguson Clinic/Spectrum Health, Division of Colorectal Surgery, Grand Rapids Medical Education Partners/Michigan State University, Grand Rapids, MI, USA

    James W. Ogilvie Jr.

  2. Division of Colorectal Surgery, Royal Brisbane and Women’s Hospital and Department of Surgery, University of Queensland, Herston, Brisbane, Australia

    Andrew R. L. Stevenson

  3. Cambridge Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

    Michael Powar

Authors
  1. James W. Ogilvie Jr.
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  2. Andrew R. L. Stevenson
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  3. Michael Powar
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Correspondence to Andrew R. L. Stevenson.

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Ogilvie, J.W., Stevenson, A.R.L. & Powar, M. Case-matched series of a non-cross-linked biologic versus non-absorbable mesh in laparoscopic ventral rectopexy. Int J Colorectal Dis 29, 1477–1483 (2014). https://doi.org/10.1007/s00384-014-2016-6

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  • DOI: https://doi.org/10.1007/s00384-014-2016-6

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