Synthetic Versus Biological Mesh-Related Erosion After Laparoscopic Ventral Mesh Rectopexy: A Systematic Review

Abstract

PurposeThis 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.MethodsA 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.ResultsEight 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.ConclusionThe 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.

Short‐ and long‐term clinical and patient‐reported outcomes following laparoscopic ventral mesh rectopexy using biological mesh for pelvic organ prolapse: a prospective cohort study of 224 consecutive patients

“…The senior author maintains that a non‐absorbable suture should be used to suture Permacol to the rectum because (i) the incorporation time for Permacol is > 15 months, (ii) the absorption time for PDS ® is 182−238 days and (iii) the rectum is 2−3 mm thicker than the vagina and therefore less susceptible to suture‐related morbidity. These results are in accordance with other published results on LVMR using biological mesh . In contrast, synthetic mesh‐related morbidity after LVMR has been reported as 1.1% (polypropylene), 3.3% (polyester) , 2.4% (various) and 4.6% (Marlex or polypropylene) (10‐year Kaplan–Meier estimate) .…”

Suture rectopexy versus ventral mesh rectopexy for complete full-thickness rectal prolapse and intussusception: systematic review and meta-analysis

“…Complete rectal prolapse (CRP) is defined as full-thickness protrusion of the rectal wall through the anus 1 . It begins as intussusception (IS) which may or may not be symptomatic 2 .…”

Ventral Rectopexy

“…25 A more recent systematic review looking at mesh erosion found there was a significantly lower incidence of mesh erosion in the biologic mesh group (0.22%) when compared with the synthetic mesh group (1.87%). 26 However, there was variability in the included studies regarding study type, length of follow-up, and type of mesh used. Further studies are needed to determine which type of mesh is safer and is associated with lower recurrence rates.…”