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Conservative treatment of intrarectal mesh migration after ventral laparoscopic rectopexy for rectal prolapse
Hadrien Tranchart1, Alain Valverde, Nicolas Goasguen
1Department of General Surgery, Diaconesses Croix Saint Simon Group Hospital, Paris, France.
Objective:
Ventral rectopexy is a validated treatment for rectal prolapse with a low morbidity rate but a risk of intrarectal mesh migration. The purpose of this study was to report the results of local transanal mesh excision for intrarectal mesh migration after ventral rectopexy.
Methods:
Between January 2004 and March 2011, 312 patients underwent laparoscopic ventral rectopexy in two hospitals. Six patients were treated for intrarectal mesh migration.
Results:
Delay between ventral rectopexy and the onset of symptoms was 53 months (4-124 months). All patients have symptoms. Imaging revealed a pelvic abscess in two cases. Intrarectal mesh migration was confirmed by anorectoscopy or clinical examination. Five patients were only treated by local transanal partial mesh excision, and one required a colostomy. Morbidity and mortality were zero. The median hospitalization time was 5 days (3-8 days). After a median postoperative follow-up period of 9 months (1-40 months), one recurrence was observed 2 months after surgery.
Conclusion:
Local transanal mesh excision for intrarectal mesh migration after laparoscopic ventral rectopexy is a feasible conservative treatment. This simple treatment produced a cure of the pelvic inflammation and closure of the fistula without compromising a more aggressive secondary treatment which was not necessary in our series.
