Abstract
BackgroundVentral 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.MethodsA 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.ResultsThirty-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.ConclusionsNo definitive conclusions on preferred mesh type can be made due to the quality of the included studies with high heterogeneity amongst them.
Highlights
Since its introduction in the early ‘00, ventral mesh rectopexy (VMR) has received wide acceptance among colorectal surgeons as a minimally invasive, safe and effective procedure to treat rectal prolapse
When Ventral mesh rectopexy (VMR) was introduced at the beginning of this century, synthetic mesh was the standard material with polypropylene and polyester grafts being the most widely used materials
To obtain an overview of mesh-related complications and recurrence after synthetic and biologic VMR, studies were considered eligible if they: (1) included patients treated for external rectal prolapse (ERP) or symptomatic high-grade internal rectal prolapse (IRP); (2) used the minimal-invasive technique based on the procedure described by D’Hoore and Pfenninckx [1]; (3) included at least 10 patients; (4) accounted for mesh-related complications and/or recurrence as an outcome variable
Summary
Since its introduction in the early ‘00, ventral mesh rectopexy (VMR) has received wide acceptance among colorectal surgeons as a minimally invasive, safe and effective procedure to treat rectal prolapse. Over the past two decades numerous studies have shown promising results regarding postoperative complications, recurrence and functional outcome compared to other rectal prolapse treatments [2,3,4]. These findings have promoted VMR to being one of the most widely practiced surgical treatments for rectal prolapse across the world [5, 6]. Ventral mesh rectopexy (VMR) is a widely accepted surgical treatment for rectal prolapse Both synthetic and biologic mesh are used. 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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