Redo ventral rectopexy: is it worthwhile?

Abstract

Background Minimally invasive ventral mesh rectopexy (VMR) is a widely used surgical treatment for posterior pelvic organ prolapse; however, evidence of the utility of revisional surgery is lacking. Our aim was to assess the technical details, safety and outcomes of redo minimally invasive VMR for patients with external rectal prolapse (ERP) recurrence or relapsed symptoms of internal rectal prolapse (IRP). Methods This is a retrospective cohort study of patients with recurrent ERP or symptomatic IRP who underwent redo minimally invasive VMR between 2011 and 2016. The study was conducted at three hospitals in Finland. Data collected retrospectively included patient demographics, in addition to perioperative and short-term postoperative findings. At follow-up, all living patients were sent a questionnaire concerning postoperative disease-related symptoms and quality of life. Results A total of 43 redo minimally invasive VMR were performed during the study period. The indication for reoperation was recurrent ERP in 22 patients and relapsed symptoms of IRP in 21 patients. In most operations (62.8%), the previously used mesh was left in situ and a new one was placed. Ten (23.3%) patients experienced complications, including 2 (4.7%) mesh-related complications. The recurrence rate was 4.5% for ERP. Three patients out of 43 were reoperated on for various reasons. One patient required postoperative laparoscopic hematoma evacuation. Patients operated on for recurrent ERP seemed to benefit more from the reoperation. Conclusions Minimally invasive redo VMR appears to be a safe and effective procedure for treating posterior pelvic floor dysfunction with acceptable recurrence and reoperation rates.

Ninety‐day morbidity of robot‐assisted redo surgery for recurrent rectal prolapse, mesh erosion and pelvic pain: lessons learned from 9 years’ experience in a tertiary referral centre

“…Laitakari et al [ 13 ] recently described a retrospective cohort of redo VMR in 43 patients. Their major complication rate is comparable to the rate found in this study (5% vs. 5%).…”

“…Another transabdominal approach, such as resection rectopexy, can be considered too, next to a perineal approach. Information on the outcome of redo surgery for recurrent RP is scarce and comes from small and heterogeneous cohorts [ 10 , 11 , 12 , 13 ].…”

Recurrence of symptoms after mesh rectopexy: different reasons and different solutions

“…A recent article from Finland reported good results of minimally invasive redo surgery for recurrent complaints after minimally invasive ventral mesh rectopexy, although complication rates were high [4]. In case of mesh erosion and chronic pelvic pain, redo surgery can carry even more risk and be less effective [5].…”