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Synthetic Versus Biological Mesh-Related Erosion After Laparoscopic Ventral Mesh Rectopexy: A Systematic Review
Andrea Balla1, Silvia Quaresima2, Sebastian Smolarek3
1Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Rome, Italy.
Purpose:
This review reports the incidence of mesh-related erosion after ventral mesh rectopexy to determine whether any difference exists in the erosion rate between synthetic and biological mesh.
Methods:
A systematic search of the MEDLINE and the Ovid databases was conducted to identify suitable articles published between 2004 and 2015. The search strategy capture terms were laparoscopic ventral mesh rectopexy, laparoscopic anterior rectopexy, robotic ventral rectopexy, and robotic anterior rectopexy.
Results:
Eight studies (3,956 patients) were included in this review. Of those patients, 3,517 patients underwent laparoscopic ventral rectopexy (LVR) using synthetic mesh and 439 using biological mesh. Sixty-six erosions were observed with synthetic mesh (26 rectal, 32 vaginal, 8 recto-vaginal fistulae) and one (perineal erosion) with biological mesh. The synthetic and the biological mesh-related erosion rates were 1.87% and 0.22%, respectively. The time between rectopexy and diagnosis of mesh erosion ranged from 1.7 to 124 months. No mesh-related mortalities were reported.
Conclusion:
The incidence of mesh-related erosion after LVR is low and is more common after the placement of synthetic mesh. The use of biological mesh for LVR seems to be a safer option; however, large, multicenter, randomized, control trials with long follow-ups are required if a definitive answer is to be obtained.
Insights
Mesh erosion after ventral mesh rectopexy is uncommon. Synthetic mesh shows a higher erosion rate (1.87%) compared to biological mesh (0.22%), suggesting biological mesh may be safer.
Area of Science:
- Surgical Innovation
- Gastrointestinal Surgery
- Biomaterials in Medicine
Background:
- Ventral mesh rectopexy is a surgical procedure for rectal prolapse.
- Mesh erosion is a known complication, necessitating comparative analysis of different mesh types.
Purpose of the Study:
- To determine the incidence of mesh-related erosion after ventral mesh rectopexy.
- To compare erosion rates between synthetic and biological mesh implants.
Main Methods:
- Systematic literature search of MEDLINE and Ovid databases (2004-2015).
- Inclusion of studies on laparoscopic or robotic ventral/anterior rectopexy.
- Analysis of mesh-related erosion data from 3,956 patients.
Main Results:
- Eight studies including 3,956 patients were reviewed.
- Synthetic mesh was used in 3,517 patients, biological mesh in 439.
- Erosion rates were 1.87% for synthetic mesh (rectal, vaginal, rectovaginal fistulae) and 0.22% for biological mesh (perineal).
Conclusions:
- Mesh-related erosion after ventral mesh rectopexy is low.
- Synthetic mesh is associated with a higher incidence of erosion compared to biological mesh.
- Biological mesh appears safer for ventral mesh rectopexy, but further large-scale, randomized trials are needed.
