Laparoscopic ventral mesh rectopexy for rectal prolapse using veritas mesh

Published Date: 16th August 2017

Publication Authors: Fretwell VL, Brannigan K, Downes C, Rajaganeshan R, Chadwick M

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Introduction

Rectal prolapse and obstructive defecation syndrome are life altering conditions, common across the age spectrum. When previously considered unfit for open abdominal surgery, elderly

patients have tended to undergo perineal procedures, known to have higher failure rates. The laparoscopic ventral mesh rectopexy (Lap-VMR) allows all patients to benefit from the abdominal

approach. Synthetic mesh erosion is the surgical complication of greatest concern and the use of biological meshes has gained increasing popularity because of this, although recent studies have shown equivalent safety and erosion rates. Traditional biological cross-linked collagen meshes are difficult to handle laparoscopic ally and do not allow for tissue integration. Veritas Collagen Matrix allows for neovascularis ation of the implanted mesh and permits replacement of the mesh with host tissue (remodelling). We chose to use Veritas as it is much easier to handle lap aros copically and we are the only centre in the Merseyside region to use it for Lap-VMR. We present our initial results. 

Method

A retrospective analysis of prospectively collected data for sequential patients undergoing Lap-VMR in this unit Since October 2013 was undertaken 

Results

Eighteen patients (M:F 1:17, median age 60.7 years) underwent Lap-VMR between October 2013 and August 2015 after pelvic floor MDT discussion. The predominant symptoms were constipation, digitation to evacuate, and prolapse. 39% had concomitant urinary symptoms. Five patients had previous anorectal procedures (Delormes, banding, haemorrhoidectomy). Veritas mesh was used in all cases, mean operative time was 180 min with average length of stay was 3 days. There were no surgical post-op complications but there was one post-operative death secondary to CCF and Pneumonia. Median follow up was 6 months. One patient

required treatment for prolapsing haemorrhoids 11 months post operatively but there were no genuine recurrences in this group and no mesh-related complications. 94% of patients reported improvement in symptoms postoperatively. 

Conclusion

Our series has shown the Veritas mesh to be safe and effective

for the Lap-VMR and early follow up demonstrates low recurrence rates, high levels of patient satisfaction and low mesh-related complication rates.

Fretwell, VL; Brannigan, K; Downes, C; Rajaganeshan, R; Chadwick, M. (2017). Laparoscopic ventral mesh rectopexy for rectal prolapse using veritas mesh - A case series . Surgical Endoscopy and Other Interventional Techniques;. 31 (Suppl 2)

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