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Incidence and surgical treatment of synthetic mesh-related infectious complications after laparoscopic ventral
F Borie1,2, T Coste3, J M Bigourdan4
1Hepatobiliary and Gastrointestinal Surgery, Nîmes University Hospital Center, 30000, Nîmes, France. frederic.borie@chu-nimes.fr.
Background:
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.
Methods:
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.
Results:
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: 31 months (range 3-62 months). 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 12 months after removal. Only one patient had worsening functional symptoms (fecal incontinence) after prosthesis removal.
Conclusions:
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.
Insights
Prosthetic-related complications after laparoscopic ventral rectopexy (LVR) were compared between polyester (PE) and polypropylene (PP) prostheses. While PE prostheses showed a higher incidence of infection and erosion, both types required surgical removal, with good functional outcomes post-treatment.
Area of Science:
- Surgical innovation and medical device technology.
- Gastrointestinal surgery and reconstructive procedures.
- Biomaterials and implantable device research.
Background:
- Prosthetic-related infection and erosion are rare but significant complications following laparoscopic ventral rectopexy (LVR).
- The comparative incidence and management of these complications between polyester (PE) and polypropylene (PP) prostheses require further investigation.
Purpose of the Study:
- To compare the incidence rate of prosthetic-related infection and erosion in patients undergoing LVR with PE versus PP prostheses.
- To evaluate and compare the surgical management strategies for these complications based on prosthesis type.
- To assess functional outcomes after managing prosthetic complications.
Main Methods:
- A retrospective analysis of 149 patients who underwent LVR with PE prostheses and 176 patients who underwent LVR with PP prostheses from January 2004 to June 2012.
- Comparison of the incidence rates of infectious and erosive complications between the two prosthesis groups.
- Description and assessment of surgical management and functional results following complication resolution.
Main Results:
- A higher incidence of prosthesis-related infection or erosion was observed in the PE group (3.3%) compared to the PP group (1.1%), though not statistically significant (p=0.16).
- The rate of erosion alone was notably higher in the PE group (3.3%) versus the PP group (0.55%) (p=0.06).
- Surgical removal of the prosthesis was necessary for all affected patients, with laparoscopic and transanal approaches utilized; functional symptoms resolved in most patients post-removal.
Conclusions:
- Surgical removal, often involving both laparoscopic and transanal techniques, is the standard treatment for prosthesis-related infection or erosion after LVR.
- Functional outcomes are generally favorable after prosthesis removal, with minimal long-term sequelae such as fecal incontinence.
