Incidence and surgical treatment of synthetic mesh-related infectious complications after laparoscopic ventral rectopexy

Abstract

Prosthetic-related infection and erosion occurring after a laparoscopic ventral rectopexy (LVR) are rare complications, and their importance is often underestimated. The aim of this study was to compare the incidence rate and surgical management of these complications in LVR patients with polyester (PE) or polypropylene (PP) prostheses. From January 2004 to June 2012, 149 patients underwent LVR with PE and 176 underwent LVR with PP. Surgical management and rate of infectious and erosive prosthesis-related complications, depending on the type of prosthesis, were described and compared. Functional results after complications were assessed. Five patients from the PE prosthesis group (3.3%), compared with two patients from the PP prosthesis group (1.1%), experienced prosthesis-related infection or erosion (p=0.16). The rate of erosion alone was 3.3% in patients with a PE prosthesis, and 0.55% in patients with a PP prosthesis (p=0.06). The average time until clinical diagnosis of a prosthesis-related complication was identical for both groups: 31months (range 3-62months). All patients underwent surgical removal of the prosthesis: For the five patients from the PE group, complete removal was performed by laparoscopy associated with a transanal procedure. For the two patients in the PP mesh group, laparoscopy was ineffective in removing the mesh which was partially removed through a subsequent transanal procedure. None of the patients had a protective stoma, and in all patients the complication had resolved 12months after removal. Only one patient had worsening functional symptoms (fecal incontinence) after prosthesis removal. When a prosthesis-related infection or erosion occurs, treatment consists in the surgical removal of the prosthesis by laparoscopy/and/or a transanal procedure. Functional symptoms do not routinely recur after prosthesis removal.