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Tan X, Li G, Li C, Kong C, Li H, Wu S. Animal models, treatment options, and biomaterials for female stress urinary incontinence. Front Bioeng Biotechnol 2024; 12:1414323. [PMID: 39267906 PMCID: PMC11390547 DOI: 10.3389/fbioe.2024.1414323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 08/20/2024] [Indexed: 09/15/2024] Open
Abstract
In the quest to tackle stress urinary incontinence (SUI), the synthesis of cutting-edge biomaterials and regenerative materials has emerged as a promising frontier. Briefly, animal models like vaginal distension and bilateral ovariectomy serve as crucial platforms for unraveling the intricacies of SUI, facilitating the evaluation of innovative treatments. The spotlight, however, shines on the development and application of novel biomaterials-ranging from urethral bulking agents to nano-gel composites-which aim to bolster urethral support and foster tissue regeneration. Furthermore, the exploration of stem cell therapies, particularly those derived from adipose tissues and urine, heralds a new era of regenerative medicine, offering potential for significant improvements in urinary function. This review encapsulates the progress in biomaterials and regenerative strategies, highlighting their pivotal role in advancing the treatment of SUI, thereby opening new avenues for effective and minimally invasive solutions.
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Affiliation(s)
- Xiyang Tan
- Shenzhen Hospital, Shanghai University of Traditional Chinese Medicine, Shenzhen, China
- Department of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
- Department of Urology, The Affiliated South China Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
| | - Guangzhi Li
- Department of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
| | - Chenchen Li
- Department of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
| | - Chenfan Kong
- Shenzhen Hospital, Shanghai University of Traditional Chinese Medicine, Shenzhen, China
- Department of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
- Department of Urology, The Affiliated South China Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
| | - Huizhen Li
- Department of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
| | - Song Wu
- Shenzhen Hospital, Shanghai University of Traditional Chinese Medicine, Shenzhen, China
- Department of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
- Department of Urology, The Affiliated South China Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
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Rudroff C, Madukkakuzhy J, Hernandez AV, Otten J, Ulrici C, Karapanos L, Ludwig S. Early safety and efficiency outcomes of a novel interdisciplinary laparoscopic resection rectopexy combined with sacrocolpopexy for women with obstructive defecation syndrome and pelvic organ prolapse: a single center study. BMC Surg 2024; 24:185. [PMID: 38877450 PMCID: PMC11177501 DOI: 10.1186/s12893-024-02474-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 06/06/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Obstructive defecation syndrome (ODS) defines a disturbed defecation process frequently associated with pelvic organ prolapse (POP) in women that substantially compromises quality of life. Conservative management offers limited relief and a surgical intervention may be required. This is characterized by individual approaches. AIM OF THE STUDY: This retrospective single center study evaluated the surgical and clinical short-term outcome of a novel interdisciplinary laparoscopic resection rectopexy (L-RRP) with mesh- sacrocolpopexy (L-SCP) for women suffering from ODS and POP. METHODS The study participants underwent surgery in an interdisciplinary laparoscopic approach. Safety was the primary endpoint, assessed via postoperative morbidity classified by Clavien-Dindo scale. Secondary outcomes included evaluation of bowel function, fecal and urinary incontinence and pelvic organ prolapse status at 12 months follow-up. Additionally, a biological mesh (BM) was offered to women, who asked for an alternative to synthetic mesh material (SM). RESULTS Of the 44 consecutive patients requiring surgery for ODS and POP, 36 patients underwent the interdisciplinary surgical approach; 28 patients with SM and 8 patients with BM. In total 5 complications occurred, four of them were classified as minor. One minor complication was observed in the BM group. One anastomotic leakage occurred in the SM group. The two ODS scores, the bowel dysfunction score, and the incontinence score improved significantly (p = 0.006, p = 0.003, p < 0.001, and p = 0.0035, respectively). Pelvic floor anatomy was fully restored (POP-Q 0) for 29 (80%) patients after surgery. 17 patients (47%) suffered from urinary incontinence before surgery, which was restored in 13 patients (76.5%). CONCLUSIONS The interdisciplinary approach with L-RRP and L-SCP and the use of a BM in a small subgroup were technically feasible, safe, and effective in this single center setting. The study's retrospective design, the small sample size and the lack of comparators limit the generalizability of the findings requiring future randomized trials. TRIAL REGISTRATION Retrospectively registered at clinicaltrials.gov, trial number NCT05910021, date of registration 06/10/2023.
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Affiliation(s)
- Claudia Rudroff
- Department of Visceral Surgery and Functional Surgery of the Lower Gastrointestinal Tract (UGI), Clinic for General and Visceral Surgery, Evangelisches Klinikum Köln Weyertal GmbH, Academic Hospital of the University of Cologne, Weyertal 76, Cologne, 50931, Germany.
| | - Joshy Madukkakuzhy
- Department of Visceral Surgery and Functional Surgery of the Lower Gastrointestinal Tract (UGI), Clinic for General and Visceral Surgery, Evangelisches Klinikum Köln Weyertal GmbH, Academic Hospital of the University of Cologne, Weyertal 76, Cologne, 50931, Germany
| | - Alberto Vega Hernandez
- Department of Visceral Surgery and Functional Surgery of the Lower Gastrointestinal Tract (UGI), Clinic for General and Visceral Surgery, Evangelisches Klinikum Köln Weyertal GmbH, Academic Hospital of the University of Cologne, Weyertal 76, Cologne, 50931, Germany
- Department of General, Visceral and Minimally Invasive Surgery, Park-Klinik Weissensee Berlin, Berlin, Germany
| | - Jakob Otten
- Department of Visceral Surgery and Functional Surgery of the Lower Gastrointestinal Tract (UGI), Clinic for General and Visceral Surgery, Evangelisches Klinikum Köln Weyertal GmbH, Academic Hospital of the University of Cologne, Weyertal 76, Cologne, 50931, Germany
- Department of Oral, Maxillofacial and Plastic Surgery, University Hospital Bonn, Bonn, Germany
| | - Christoph Ulrici
- Department of Visceral Surgery and Functional Surgery of the Lower Gastrointestinal Tract (UGI), Clinic for General and Visceral Surgery, Evangelisches Klinikum Köln Weyertal GmbH, Academic Hospital of the University of Cologne, Weyertal 76, Cologne, 50931, Germany
- Department of General and Visceral Surgery, St.Josef Hospital Bonn-Beuel, GFO Kliniken Bonn, Bonn, Germany
| | - Leonidas Karapanos
- Department of Urology, Division of Neurourology, University Hospital of Cologne and Medical Faculty Cologne, 50931, Cologne, Germany
- Department of Urology, Municipal Hospital of Leverkusen, Leverkusen, Germany
| | - Sebastian Ludwig
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, University Hospital of Cologne and Medical Faculty Cologne, 50931, Cologne, Germany
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Rudroff C, Ludwig S. Laparoscopic resection rectopexy (RRP) combined with mesh sacrocolpopexy (SCP) for obstructed defecation syndrome with pelvic organ prolapse in an interdisciplinary approach. Facts Views Vis Obgyn 2024; 16:231-236. [PMID: 38950538 PMCID: PMC11366123 DOI: 10.52054/fvvo.16.2.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
Background Obstructive defecation syndrome (ODS) is frequently associated with pelvic organ prolapse (POP) and compromises the quality of life in affected patients. In cases conservative treatment fails surgical therapy is required. Objectives The video case study combines a laparoscopic resection rectopexy (RRP) with a mesh sacrocolpopexy (SCP) in an interdisciplinary surgical approach. Materials and Methods In this video an 86-year-old woman with ODS and POP, suffering from a dolichocolon with rectal intussusception, an apical prolapse after total hysterectomy 1990, and occasional stress urinary incontinence underwent interdisciplinary laparoscopic surgery. A tubular anterior rectal and sigmoid resection with suture rectopexy as in a resection rectopexy (RRP) was combined with a sacrocolpopexy (SCP) using a synthetic mesh. Main outcome measures Surgical outcome including postoperative morbidity, functional bowel evacuation, and POP reconstitution as in POP-Q score after surgery were documented. Results No intra- or postoperative complications occurred. At 6 months follow-up clinical outcomes for ODS, bowel dysfunction, and faecal control were improved. Anatomical outcome for POP and stress urinary incontinence symptoms were corrected. Conclusions We report a promising interdisciplinary surgical approach as a single treatment option for the complex medical condition of women suffering from ODS and POP combining laparoscopic RRP with SCP. This surgical approach proved to be feasible, safe, and effective.
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Habeeb TAAM, Podda M, Chiaretti M, Kechagias A, Lledó JB, Kalmoush AE, Mustafa FM, Nassar MS, Labib MF, Teama SRA, Elshafey MH, Elbelkasi H, Alsaad MIA, Sallam AM, Ashour H, Mansour MI, Mostafa A, Elshahidy TM, Yehia AM, Rushdy T, Ramadan A, Hamed AEM, Yassin MA, Metwalli AEM. Comparative study of laparoscopic ventral mesh rectopexy versus perineal stapler resection for external full-thickness rectal prolapse in elderly patients: enhanced outcomes and reduced recurrence rates-a retrospective cohort study. Tech Coloproctol 2024; 28:48. [PMID: 38619626 PMCID: PMC11018677 DOI: 10.1007/s10151-024-02919-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/16/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND In elderly patients with external full-thickness rectal prolapse (EFTRP), the exact differences in postoperative recurrence and functional outcomes between laparoscopic ventral mesh rectopexy (LVMR) and perineal stapler resection (PSR) have not yet been investigated. METHODS We conducted a retrospective multicenter study on 330 elderly patients divided into LVMR group (n = 250) and PSR (n = 80) from April 2012 to April 2019. Patients were evaluated before and after surgery by Wexner incontinence scale, Altomare constipation scale, and patient satisfaction questionnaire. The primary outcomes were incidence and risk factors for EFTRP recurrence. Secondary outcomes were postoperative incontinence, constipation, and patient satisfaction. RESULTS LVMR was associated with fewer postoperative complications (p < 0.001), lower prolapse recurrence (p < 0.001), lower Wexner incontinence score (p = 0.03), and lower Altomare's score (p = 0.047). Furthermore, LVMR demonstrated a significantly higher surgery-recurrence interval (p < 0.001), incontinence improvement (p = 0.019), and patient satisfaction (p < 0.001) than PSR. Three and 13 patients developed new symptoms in LVMR and PSR, respectively. The predictors for prolapse recurrence were LVMR (associated with 93% risk reduction of recurrence, OR 0.067, 95% CI 0.03-0.347, p = 0.001), symptom duration (prolonged duration was associated with an increased risk of recurrence, OR 1.131, 95% CI 1.036-1.236, p = 0.006), and length of prolapse (increased length was associated with a high recurrence risk (OR = 1.407, 95% CI = 1.197-1.655, p < 0.001). CONCLUSIONS LVMR is safe for EFTRP treatment in elderly patients with low recurrence, and improved postoperative functional outcomes. TRIAL REGISTRATION Clinical Trial.gov (NCT05915936), retrospectively registered on June 14, 2023.
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Affiliation(s)
- T A A M Habeeb
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt.
| | - M Podda
- Department of Surgical Science, Cagliari University Hospital, Monserrato, 09042, Cagliari, Italy
| | - M Chiaretti
- Paride Stefanini General and Specialist Surgery Department, Sapienza University of Rome IT, Rome, Italy
| | - A Kechagias
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere, Finland
| | - J B Lledó
- Department of Surgery, La Fe University Hospital, Valencia, Spain
| | | | - Fawzy M Mustafa
- General Surgery Department, Faculty of Medicine, Al-Azher University, Cairo, Egypt
| | | | - Mohamed Fathy Labib
- General Surgery Department, Faculty of Medicine, Al-Azher University, Cairo, Egypt
| | | | | | - Hamdi Elbelkasi
- General Surgery Department, Mataryia Teaching Hospital (GOTHI), Cairo, Egypt
| | | | - Ahmed M Sallam
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Hassan Ashour
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Mohamed Ibrahim Mansour
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Abdelshafy Mostafa
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Tamer Mohamed Elshahidy
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Ahmed M Yehia
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Tamer Rushdy
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Alaaedin Ramadan
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Abd Elwahab M Hamed
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Mahmoud Abdou Yassin
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Abd-Elrahman M Metwalli
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
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Yasar NF, Waked W, Sturiale A, Fabiani B, Naldini G. Could robotic-assisted surgery reduce mesh-related complications after ventral mesh rectopexy? Experience of a tertiary centre and systematic review of the literature. Colorectal Dis 2024; 26:609-621. [PMID: 38459408 DOI: 10.1111/codi.16938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 03/10/2024]
Abstract
AIM The development of robotic assistance has made dissection and suturing in the deep pelvis much easier. The augmented quality of the images and the articulation of the robotic arms have also enabled a more precise dissection. The aim of this study is to present the data on robotic-assisted ventral mesh rectopexy procedures in a university hospital and examine the literature in terms of mesh erosion. METHOD The electronic databases Pubmed, Embase and Cochrane were searched. Studies from January 2004 until January 2023 in the English language were included. Studies which included fewer than 10 patients were excluded. Laparoscopic or robotic-assisted ventral mesh rectopexies were included. Mesh erosion rates following laparoscopic or robotic-assisted ventral mesh rectopexies were measured. RESULTS Overall, the systematic review presents 5911 patients from 43 studies who underwent laparoscopic ventral mesh rectopexy compared with 746 patients treated with robotic-assisted ventral mesh rectopexy from six studies and our centre. Mesh erosion was rare in both groups; however, the prevalence was greater in the laparoscopy group (0.90% vs. 0.27%). CONCLUSION The mesh erosion rates are very low with robotic-assisted ventral mesh rectopexy. For precise results, more studies and experience in robotic surgery are required.
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Affiliation(s)
- Necdet F Yasar
- Department of General Surgery, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Weam Waked
- Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel
| | - Alessandro Sturiale
- Proctology and Perineal Surgical Unit, Cisanello University Hospital, Pisa, Italy
| | - Bernardina Fabiani
- Proctology and Perineal Surgical Unit, Cisanello University Hospital, Pisa, Italy
| | - Gabriele Naldini
- Proctology and Perineal Surgical Unit, Cisanello University Hospital, Pisa, Italy
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Usman M, Khan IU, Hadi A. Outcomes of Laparoscopic Suture vs Mesh Rectopexy for Complete Rectal Prolapse. Cureus 2023; 15:e50758. [PMID: 38239515 PMCID: PMC10794792 DOI: 10.7759/cureus.50758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/22/2024] Open
Abstract
Objective To compare outcomes of laparoscopic suture and laparoscopic mesh rectopexy for the treatment of complete rectal prolapse in adults. Materials and methods This study was conducted between December 2020 to December 2022, involving 75 patients (Group A: 34; Group B: 41). Inclusion criteria encompassed confirmed complete rectal prolapse. Preoperative measures included comprehensive assessments, mechanical bowel cleansing, prophylactic antibiotics, and rectal irrigation. Surgical techniques involved laparoscopic suture rectopexy for Group A and laparoscopic mesh rectopexy for Group B. Postoperative care and follow-up evaluations were conducted. Results Group A demonstrated advantages in terms of shorter operative times, quicker bowel activity resumption, and reduced hospital stays. Intraoperative bleeding was absent in Group A, while wound-related complications were higher in Group B. Recurrence rates were lower in Group A (2.9%) compared to Group B (9.8%). Both groups exhibited improvements in incontinence grades postoperatively. Constipation increased in both groups. Conclusion Both techniques are effective in treating complete rectal prolapse, each with its advantages and considerations. Group A showed potential benefits in terms of operative efficiency and fewer complications, albeit with a potential for increased recurrence. The study emphasizes the need for individualized patient care, considering factors such as operative characteristics, postoperative outcomes, and patient preferences.
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Affiliation(s)
- Muhammad Usman
- Department of General Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Imran Uddin Khan
- Department of General Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Ainul Hadi
- Department of General Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
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Olatunbode O, Rangarajan S, Russell V, Viswanath YKS, Reddy A. A quantitative study to explore functional outcomes following laparoscopic ventral mesh rectopexy for rectal prolapse. Ann R Coll Surg Engl 2022; 104:449-455. [PMID: 34939835 PMCID: PMC9158073 DOI: 10.1308/rcsann.2021.0212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Rectal prolapse is a life-altering problem and laparoscopic ventral mesh rectopexy (LVMR) is emerging as the surgical intervention of choice. However, the literature is ambiguous on its effect on bowel function and sparse as regards bladder and sexual function. This study assesses short-term functional outcomes following LVMR. MATERIALS AND METHODS This quantitative retrospective study with a pretest-post-test design included 130 adults who had undergone LVMR from October 2010 to December 2018 in a tertiary centre. Analysis with paired-samples t-test and Wilcoxon matched pairs test was done using SPSS (v26). RESULTS The median age was 58 years (interquartile range, 48-74 years); 123 (94.6%) were female. The median length of stay was two days (interquartile range, 1-2 days). A total of 104 (80%) sets of medical notes were reviewed. One patient had recurrence of rectal prolapse. Synthetic mesh was used in 24 patients (23.1%) and biological mesh in 80 (76.9%). One patient had extrusion of a synthetic mesh and required surgery; 31(23.8%) completed the Electronic Patient Assessment Questionnaire for Pelvic Floor. Overall, the improvement in bladder function was not statistically significant (p = 0.670). A statistically significant improvement was seen for all bowel symptoms (p = 0.002) excluding constipation (p = 0.295). Irritable bowel symptoms associated with rectal prolapse improved significantly following LVMR (p = 0.001). Vaginal prolapse (p < 0.0005), dyspareunia (p = 0.001) and bowel symptoms affecting sexual intercourse (p = 0.01) improved, but improvement in overall sexual function was not statistically significant (p = 0.081). CONCLUSIONS LVMR improves bowel function overall, although it can worsen constipation. It has the potential to improve sexual function but makes negligible difference to bladder function.
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Affiliation(s)
- O Olatunbode
- James Cook University Hospital, Middlesbrough, UK
| | - S Rangarajan
- James Cook University Hospital, Middlesbrough, UK
| | - V Russell
- School of Health and Social Care, Teesside University, Middlesbrough, UK
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van der Schans EM, Boom MA, El Moumni M, Verheijen PM, Broeders IAMJ, Consten ECJ. Mesh-related complications and recurrence after ventral mesh rectopexy with synthetic versus biologic mesh: a systematic review and meta-analysis. Tech Coloproctol 2022; 26:85-98. [PMID: 34812970 PMCID: PMC8763765 DOI: 10.1007/s10151-021-02534-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/27/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ventral mesh rectopexy (VMR) is a widely accepted surgical treatment for rectal prolapse. Both synthetic and biologic mesh are used. No consensus exists on the preferred type of mesh material. The aim of this systematic review and meta-analysis was to establish an overview of the current literature on mesh-related complications and recurrence after VMR with synthetic or biologic mesh to aid evidence-based decision making in preferred mesh material. METHODS A systematic search of the electronic databases of PubMed, Embase and Cochrane was performed (from inception until September 2020). Studies evaluating patients who underwent VMR with synthetic or biologic mesh were eligible. The MINORS score was used for quality assessment. RESULTS Thirty-two studies were eligible after qualitative assessment. Eleven studies reported on mesh-related complications including 4001 patients treated with synthetic mesh and 762 treated with biologic mesh. The incidence of mesh-related complications ranged between 0 and 2.4% after synthetic versus 0-0.7% after biologic VMR. Synthetic mesh studies showed a pooled incidence of mesh-related complications of 1.0% (95% CI 0.5-1.7). Data of biologic mesh studies could not be pooled. Twenty-nine studies reported on the risk of recurrence in 2371 synthetic mesh patients and 602 biologic mesh patients. The risk of recurrence varied between 1.1 and 18.8% for synthetic VMR versus 0-15.4% for biologic VMR. Cumulative incidence of recurrence was found to be 6.1% (95% CI 4.3-8.1) and 5.8% (95% CI 2.9-9.6), respectively. The clinical and statistical heterogeneity was high. CONCLUSIONS No definitive conclusions on preferred mesh type can be made due to the quality of the included studies with high heterogeneity amongst them.
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Affiliation(s)
- E M van der Schans
- Department of Surgery, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands.
- Faculty of Electrical Engineering, Mathematics and Computer Science, Institute of Technical Medicine, Twente University, Enschede, The Netherlands.
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - M A Boom
- Department of Surgery, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands
| | - M El Moumni
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - P M Verheijen
- Department of Surgery, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands
| | - I A M J Broeders
- Department of Surgery, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands
- Faculty of Electrical Engineering, Mathematics and Computer Science, Institute of Technical Medicine, Twente University, Enschede, The Netherlands
| | - E C J Consten
- Department of Surgery, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Tsiaousidou A, MacDonald L, Shalli K. Mesh safety in pelvic surgery: Our experience and outcome of biological mesh used in laparoscopic ventral mesh rectopexy. World J Clin Cases 2022; 10:891-898. [PMID: 35127904 PMCID: PMC8790465 DOI: 10.12998/wjcc.v10.i3.891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 11/08/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND 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.
AIM To assess the safety of the mesh and the outcome of the procedure.
METHODS 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.
RESULTS 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.
CONCLUSION 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.
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Affiliation(s)
- Anastasia Tsiaousidou
- Department of Surgery, Wishaw University Hospital, Wishaw ML2 0DP, Lanarkshire, United Kingdom
| | - Linda MacDonald
- Department of Surgery, Wishaw University Hospital, Wishaw ML2 0DP, Lanarkshire, United Kingdom
| | - Kawan Shalli
- Department of Surgery, Wishaw University Hospital, Wishaw ML2 0DP, Lanarkshire, United Kingdom
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Ventral Prosthesis Rectopexy for obstructed defaecation syndrome: a systematic review and meta-analysis. Updates Surg 2021; 74:11-21. [PMID: 34665411 DOI: 10.1007/s13304-021-01177-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
Obstructed Defecation Syndrome (ODS) is a rather complex entity concerning mainly females and causing primarily constipation. Surgical treatment in the form of Ventral Prosthesis Rectopexy (VPR) has been proposed and seems to have the best outcomes. However, the selection criteria of patients to undergo this kind of operation are not clear and the reported outcomes are mainly short-term and data on long-term outcomes is scarce. This study assesses new evidence on the efficacy of VPR for the treatment of ODS, specifically focusing on inclusion criteria for surgery and the long-term outcomes. A search was performed of MEDLINE, EMBASE, Ovid and Cochrane databases on all studies reporting on VPR for ODS from 2000 to March 2020. No language restrictions were made. All studies on VPR were reviewed systematically. The main outcomes were intra-operative complications, conversion, procedure duration, short-term mortality and morbidity, length of stay, faecal incontinence and constipation, quality of life (QoL) score and patient satisfaction. Quality assessment and data extraction were performed independently by three observers. Fourteen studies including 963 patients were eligible for analysis. The immediate postoperative morbidity rate was 8.9%. A significant improvement in constipation symptoms was observed in the 12-month postoperative period for ODS (p < 0.0001). Current evidence shows that VPR offers symptomatic relief to the majority of patients with ODS, improving both constipation-like symptoms and faecal incontinence for at least 1-2 years postoperatively. Some studies report on functional results after longer follow-up, showing sustainable improvement, although in a lesser extent.
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Maeda Y, Espin-Basany E, Gorissen K, Kim M, Lehur PA, Lundby L, Negoi I, Norcic G, O'Connell PR, Rautio T, van Geluwe B, van Ramshorst GH, Warwick A, Vaizey CJ. European Society of Coloproctology guidance on the use of mesh in the pelvis in colorectal surgery. Colorectal Dis 2021; 23:2228-2285. [PMID: 34060715 DOI: 10.1111/codi.15718] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/14/2021] [Accepted: 03/23/2021] [Indexed: 12/31/2022]
Abstract
This is a comprehensive and rigorous review of currently available data on the use of mesh in the pelvis in colorectal surgery. This guideline outlines the limitations of available data and the challenges of interpretation, followed by best possible recommendations.
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Affiliation(s)
- Yasuko Maeda
- Cumberland Infirmary and University of Edinburgh, Carlisle, UK
| | | | | | - Mia Kim
- Department of General, Gastrointestinal, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | | | - Lilli Lundby
- Department of Surgery Pelvic Floor Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Ionut Negoi
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Gregor Norcic
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - P Ronan O'Connell
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Tero Rautio
- Medical Research Center, University of Oulu, Oulu, Finland
| | | | | | - Andrea Warwick
- QEII Jubilee Hospital, Acacia Ridge, Queensland, Australia
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Harvey MA, Chih HJ, Geoffrion R, Amir B, Bhide A, Miotla P, Rosier PFWM, Offiah I, Pal M, Alas AN. International Urogynecology Consultation Chapter 1 Committee 5: relationship of pelvic organ prolapse to associated pelvic floor dysfunction symptoms: lower urinary tract, bowel, sexual dysfunction and abdominopelvic pain. Int Urogynecol J 2021; 32:2575-2594. [PMID: 34338825 DOI: 10.1007/s00192-021-04941-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/11/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This article from Chapter 1 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) establishes the prevalence of lower urinary tract disorders, bowel symptoms, vulvo-vaginal/lower abdominal/back pain and sexual dysfunction in women with POP. METHODS An international group of nine urogynecologists/urologists and one medical student performed a search of the literature using pre-specified search terms in Ovid, MEDLINE, Embase and CINAHL from January 2000 to March 2019. Publications were eliminated if not relevant or they did not include clear definitions of POP or the symptoms associated with POP. Definitions of POP needed to include both a physical examination finding using a validated examination technique and the complaint of a bothersome vaginal bulge. Symptoms were categorized into symptom groups for ease of evaluation. The Specialist Unit for Review Evidence (SURE) was used to evaluate for quality of the included articles. The resulting list of articles was used to determine the prevalence of various symptoms in women with POP. Cohort studies were used to evaluate for possible causation of POP as either causing or worsening the symptom category. RESULTS The original search yielded over 12,000 references, of which 50 were used. More than 50% of women with POP report lower urinary tract symptoms. Cohort studies suggest that women with POP have more obstructive lower urinary tract symptoms than women without POP. Pain described in various ways is frequently reported in women with POP, with low back pain being the most common pain symptom reported in 45% of women with POP. In cohort studies those with POP had more pain complaints than those without POP. Sexual dysfunction is reported by over half of women with POP and obstructed intercourse in 37-100% of women with POP. Approximately 40% of women have complaints of bowel symptoms. There was no difference in the median prevalence of bowel symptoms in those with and without POP in cohort studies. CONCLUSIONS The prevalence of lower urinary tract disorders, bowel symptoms, vulvo-vaginal/lower abdominal/back pain and sexual dysfunction in women with POP are common but inconsistently reported. There are few data on incidence of associated symptoms with POP, and cohort studies evaluating causality are rare or inconsistent. Obstructive voiding, lower abdominal and pelvic pain, and sexual dysfunction are most frequently associated with POP.
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Affiliation(s)
- Marie-Andrée Harvey
- Department of Obstetrics and Gynecology Queen's University, Victory 4, Kingston Health Science Centre, 76 Stuart St, Kingston, Ontario, K7L 2V7, Canada.
| | - Hui Ju Chih
- Department of Obstetrics and Gynecology Queen's University, Victory 4, Kingston Health Science Centre, 76 Stuart St, Kingston, Ontario, K7L 2V7, Canada
| | - Roxana Geoffrion
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - Baharak Amir
- Department of Obstetrics & Gynecology, Division of Urogynecology and Pelvic Floor Surgery, Dalhousie University, Halifax, Canada
| | - Alka Bhide
- Department of Obstetrics and Gynecology, Imperial College Healthcare NHS Trust, London, UK
| | - Pawel Miotla
- 2nd Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Peter F W M Rosier
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ifeoma Offiah
- Department Obstetrics and Gynecology, Derriford Hospital Healthcare, NHS Trust, Plymouth, UK
| | - Manidip Pal
- Department of Obstetrics and Gynecology College of Medicine & JNM Hospital, WBUHS, Kalyani, India
| | - Alexandriah Nicole Alas
- Department of Obstetrics and Gynecology, University of Texas Health Sciences, San Antonio, TX, USA
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Yamamoto T, Hyakudomi R, Takai K, Taniura T, Uchida Y, Ishitobi K, Hirahara N, Tajima Y. Altemeier perineal rectosigmoidectomy with indocyanine green fluorescence imaging for a female adolescent with complete rectal prolapse: A case report. World J Clin Cases 2021; 9:847-853. [PMID: 33585631 PMCID: PMC7852635 DOI: 10.12998/wjcc.v9.i4.847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/17/2020] [Accepted: 12/27/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rectal prolapse in young women is rare. Although laparoscopic ventral mesh rectopexy is the standard procedure because of its lower recurrence rate, postoperative infertility is a concern. Perineal rectosigmoidectomy (Altemeier procedure) is useful for these patients. However, the risk of anastomotic leakage should be considered. Recently, the usefulness of fluorescence imaging with indocyanine green (ICG) to prevent anastomotic leakage was reported. We report a case of an adolescent woman with complete rectal prolapse who underwent ICG fluorescence imaging-assisted Altemeier rectosigmoidectomy.
CASE SUMMARY A 17-year-old woman who had a mental disorder was admitted to our hospital for treatment for water intoxication. The patient also suffered from rectal prolapse, approximately 3 mo before admission. She was referred to our surgical department because recurrent rectal prolapse could worsen her psychiatric disorder. Approximately 10 cm of complete rectal prolapse was observed. However, the mean maximum anal resting and constriction pressures were within normal limits on anorectal manometry. Because she had the desire to bear children in the future, she underwent Altemeier perineal rectosigmoidectomy to prevent surgery-related infertility. We performed ICG fluorescence imaging at the same time as surgery to reduce the risk of anastomotic leakage. Her postoperative course was uneventful, and the rectal prolapse was completely resolved. She continued to do well 18 mo after surgery, without recurrence of the rectal prolapse.
CONCLUSION ICG fluorescence imaging-assisted Altemeier perineal rectosigmoidectomy is useful in preventing postoperative anastomotic leakage in young as well as elderly patients.
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Affiliation(s)
- Tetsu Yamamoto
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Ryoji Hyakudomi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Kiyoe Takai
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Takahito Taniura
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Yuki Uchida
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Kazunari Ishitobi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Noriyuki Hirahara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
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Impact of Suture Type on Erosion Rate After Laparoscopic Ventral Mesh Rectopexy: A Case-Matched Study. Dis Colon Rectum 2019; 62:1512-1517. [PMID: 31569096 DOI: 10.1097/dcr.0000000000001510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND There has been increasing concern and scrutiny in the use of mesh for certain pelvic organ prolapse procedures. However, mesh erosion was often associated with sites of suture fixation of the mesh to the rectum or vagina. Thus, in response to this finding, we replaced our suture material with absorbable monofilament suture. OBJECTIVE The purpose of this study was to compare the rates of mesh-related complications after laparoscopic ventral mesh rectopexy, according to the type of suture used in fixation of mesh. DESIGN This was retrospective cohort study. SETTINGS This study was performed at a high-volume, tertiary care center. It was conducted using a prospective database including patients who underwent laparoscopic ventral mesh rectopexy over a 7-year period. PATIENTS A total of 495 cases were included; 296 (60%) laparoscopic ventral mesh rectopexies were performed using a nonabsorbable suture compared with 199 (40%) with an absorbable suture in a case-matched analysis. In addition, 151 cases of laparoscopic ventral mesh rectopexy with nonabsorbable were matched based on age, sex, and time of follow-up, with an equal number of patients using absorbable monofilament suture. MAIN OUTCOMES MEASURES Primary outcome was symptomatic mesh erosion after rectopexy. Secondary outcomes included other mesh-related complications and/or reoperations. RESULTS The erosion rate was 2% (6/495) in the nonabsorbable suture group, including 4 erosions into the rectum and 2 into the vagina. There was no erosion in the group with absorbable suture. This difference was maintained after matching: after a median follow-up of 6 (12) months, there was no erosion in the absorbable suture group versus 3.3% erosion (n = 5) in the nonabsorbable suture group (p = 0.03). LIMITATIONS This study was limited by its retrospective design. CONCLUSIONS Mesh-related complications are reduced using absorbable sutures compared with nonabsorbable sutures when performing laparoscopic ventral mesh rectopexy with synthetic mesh without an increase in rectopexy failures. See Video Abstract at http://links.lww.com/DCR/B49. IMPACTO DEL TIPO DE SUTURA EN LA TASA DE EROSIóN DESPUéS DE LA RECTOPEXIA VENTRAL LAPAROSCóPICA CON MALLA: UN ESTUDIO DE CASOS EMPAREJADOS: Ha habido una creciente preocupación y escrutinio en el uso de la malla para ciertos procedimientos de prolapso de órganos pélvicos. Sin embargo, la erosión de la malla a menudo se asoció con sitios de fijación de sutura de la malla al recto o la vagina. Por lo tanto, en respuesta a este hallazgo, reemplazamos nuestro material de sutura con sutura de monofilamento absorbible.Comparar las tasas de complicaciones relacionadas con la malla después de la rectopexia laparoscópica de malla ventral, de acuerdo al tipo de sutura utilizada en la fijación de la malla.Este fue un estudio de cohorte retrospectivo.Este estudio se realizó en un centro de atención de tercer nivel de alto volumen. Se realizó utilizando una base de datos prospectiva que incluía pacientes que se sometieron a una rectopexia de malla ventral laparoscópica durante un período de 7 años.Se incluyeron un total de 495 casos; 296 (60%) rectopexias de malla ventral laparoscópica utilizando una sutura no reabsorbible en comparación con 199 (40%) con una sutura absorbible en un análisis de casos emparejados. Además, 151 casos de rectopexia ventral laparoscópica con malla no absorbible se emparejaron según la edad, el sexo y el tiempo de seguimiento con un número igual de pacientes que usaban sutura de monofilamento absorbible.La medida de resultado primaria fue la erosión sintomática de la malla después de la rectopexia. La medida de resultado secundarias incluyeron otras complicaciones y/o reoperaciones relacionadas con la malla.La tasa de erosión fue del 2% (6/495) en el grupo de sutura no absorbible; 4 erosiones en el recto y 2 en la vagina. No hubo erosión en el grupo con sutura absorbible. Esta diferencia se mantuvo después del emparejamiento: después de una mediana de seguimiento de 6 (12) meses, no hubo erosión en el grupo de sutura absorbible versus 3.3% de erosión (n = 5) en el grupo de sutura no absorbible (p = 0.03).Este estudio estuvo limitado por su diseño retrospectivo.Las complicaciones relacionadas con la malla se reducen utilizando suturas absorbibles en comparación con las suturas no absorbibles cuando se realiza la rectopexia de malla ventral laparoscópica con malla sintética, sin un aumento en los fracasos de rectopexia. Vea el Resumen del Video en http://links.lww.com/DCR/B49.
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Hidaka J, Elfeki H, Duelund-Jakobsen J, Laurberg S, Lundby L. Functional Outcome after Laparoscopic Posterior Sutured Rectopexy Versus Ventral Mesh Rectopexy for Rectal Prolapse: Six-year Follow-up of a Double-blind, Randomized Single-center Study. EClinicalMedicine 2019; 16:18-22. [PMID: 31832616 PMCID: PMC6890942 DOI: 10.1016/j.eclinm.2019.08.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/14/2019] [Accepted: 08/21/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Laparoscopic ventral mesh rectopexy (LVMR) for rectal prolapse has been implemented to reduce postoperative bowel symptoms. The preoperative-to-postoperative change in a double-blinded, randomized study comparing it to laparoscopic posterior sutured rectopexy (LPSR) found no significant difference between the two procedures after one year. The aim of this study was to investigate the long-term functional outcomes. METHODS From November 2006-January 2014, 75 patients were randomized to LVMR (n = 37) or LPSR (n = 38). In March 2017, questionnaires containing constipation symptom score (PAC-SYM), quality of life score (PAC-QoL), obstructed defecation score (ODS), Cleveland clinic constipation and incontinence scores (CCCS, CCIS) were mailed to all the patients included in the RCT. Prolapse recurrences and mesh complications were recorded. FINDING Sixty-nine patients were available for long-term follow-up. Questionnaires were completed by 64 patients (94.4%). The median follow-up was 6.1 years. The total PAC-QoL was significantly lower in the LVMR group 0.26 (0.14-0.83) compared to the LPSR group 0.93(0.32-1.61)(P = 0.008). The total PAC-SYM was significantly lower in the LVMR group 0.5 (0.21-0.87) compared to the LPSR group 1.0 (0.5-1.5)(P = 0.031). Except for CCIS, the ODS and the CCCS significantly favored the LVMR group at six years (P = 0.011 & 0.017). Only three(8.82%) patients in the LVMR group developed recurrence compared to seven(23.33%) in the LPSR group (P = 0.111). INTERPRETATION The long-term functional outcome after LVMR is superior to that after LPSR. Larger multicenter studies are warranted. FUNDING None.
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Affiliation(s)
- Jin Hidaka
- Department of Surgery, Aarhus University Hospital, Denmark
- Corresponding author at: Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
| | - Hossam Elfeki
- Department of Surgery, Aarhus University Hospital, Denmark
- Department of surgery, Mansoura University Hospital, Mansoura, Egypt
| | | | - Søren Laurberg
- Department of Surgery, Aarhus University Hospital, Denmark
| | - Lilli Lundby
- Department of Surgery, Aarhus University Hospital, Denmark
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A prospective pilot study on MRI visibility of iron oxide-impregnated polyvinylidene fluoride mesh after ventral rectopexy. Tech Coloproctol 2019; 23:633-637. [PMID: 31270653 PMCID: PMC6692291 DOI: 10.1007/s10151-019-02022-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/20/2019] [Indexed: 12/12/2022]
Abstract
Background Magnetic resonance imaging (MRI) provides excellent information about pelvic anatomy after ventral rectopexy, but the position of the conventional mesh is not seen constantly. Iron oxide-impregnated polyvinylidene fluoride (PVDF) meshes are proven to have MRI visibility in hernia or vaginal reconstructive surgery. This prospective pilot study was designed to assess the visualization, position, and shape of the magnetic resonance (MR)–visible synthetic pelvic mesh used in minimally invasive ventral rectopexy. Methods Eight patients with pelvic organ prolapse were recruited for laparoscopic (LVMR) or robotic-assisted ventral mesh rectopexy (RVMR) with a synthetic MR–visible PVDF mesh. A follow-up visit was scheduled at 3 months after surgery. MR imaging was performed to evaluate the position and dimensions of the mesh and anatomical result. The visibility of the mesh in each sequence was assessed subjectively. Results The visibility of the mesh was best on T1-weighted flash images. The mesh was also well visualized on T2-weighted sagittal images. T2-weighted images, in general, provided best visualization of the surrounding anatomical structures and enabled assessment of the mesh fixation. Conclusions T2 sagittal and T1-weighted flash images provide the best information about the position and integrity of the iron oxide-impregnated PVDF mesh after LVMR or RVMR with a short examination time.
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Gouriou C, Chambaz M, Ropert A, Bouguen G, Desfourneaux V, Siproudhis L, Brochard C. A systematic literature review on solitary rectal ulcer syndrome: is there a therapeutic consensus in 2018? Int J Colorectal Dis 2018; 33:1647-1655. [PMID: 30206681 DOI: 10.1007/s00384-018-3162-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE To screen all treatments tested for solitary rectal ulcer syndrome (SRUS) without rectal prolapse and to assess their efficacy. METHOD A systematic review was performed according to the PRISMA guidelines, focusing on the treatment of SRUS without rectal prolapse. The types of treatment and their efficacy were collected and critically assessed. RESULTS A selection of 20 studies among the 470 publications focusing on SRUS provided suitable data for a total of 516 patients. Only 2 studies were randomised prospective trials that focused on argon plasma treatment. The mean follow-up was 21.8 months and ranged from 0.25 to 90 months. Most of the studies focused on surgery, including rectopexy, stapled transanal rectal resection, excision of the ulcer, the Delorme procedure, proctectomy, low anterior resection, and ostomy. Populations of the studies were heterogeneous and selected outcomes were specific (failure of medical or surgical treatment). Conservative treatment (high-fibre diet, laxatives, change of defecatory habits, and biofeedback treatment) induced a symptomatic improvement in 71/91 patients (63.6%) and healing of mucosal lesion in 17/51 patients (33.3%). Surgeries (all types) improved SRUS in 77% (54-100%) of patients. Argon plasma coagulation is a promising technique but longer follow-up is necessary. CONCLUSIONS The general quality of the studies focusing on the treatment of SRUS was poor due to the heterogeneity of the population, the sample size of the cohorts, and the heterogeneity of efficacy assessments. The therapeutic approach appears to be multimodal and multidisciplinary and validated in centres of expertise. Further studies evaluating multimodal strategies are needed.
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Affiliation(s)
- Claire Gouriou
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, 2 rue Henri le Guillou, 35033, Rennes Cedex, France
| | - Marion Chambaz
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, 2 rue Henri le Guillou, 35033, Rennes Cedex, France
| | - Alain Ropert
- Service d'Explorations Fonctionnelles Digestives, CHU Pontchaillou, Université de Rennes 1, Rennes, France.,CIC 1414, INPHY, Université de Rennes 1, Rennes, France
| | - Guillaume Bouguen
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, 2 rue Henri le Guillou, 35033, Rennes Cedex, France.,CIC 1414, INPHY, Université de Rennes 1, Rennes, France.,INSERM U1241, Université de Rennes 1, Rennes, France
| | - Véronique Desfourneaux
- Service de Chirurgie Viscérale, CHU Pontchaillou, Université de Rennes 1, Rennes, France
| | - Laurent Siproudhis
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, 2 rue Henri le Guillou, 35033, Rennes Cedex, France.,CIC 1414, INPHY, Université de Rennes 1, Rennes, France.,INSERM U1241, Université de Rennes 1, Rennes, France
| | - Charlène Brochard
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, 2 rue Henri le Guillou, 35033, Rennes Cedex, France. .,Service d'Explorations Fonctionnelles Digestives, CHU Pontchaillou, Université de Rennes 1, Rennes, France. .,CIC 1414, INPHY, Université de Rennes 1, Rennes, France. .,INSERM U1241, Université de Rennes 1, Rennes, France.
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Gosselink MP. Commentary on 'Short- and long-term clinical and patient-reported outcomes following laparoscopic ventral mesh rectopexy using biological mesh for pelvic organ prolapse: a prospective cohort study of 224 consecutive patients'. Colorectal Dis 2018; 20:436-437. [PMID: 29717564 DOI: 10.1111/codi.13980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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