Laparoscopic ventral mesh rectopexy is a safe and effective method for treating symptomatic complex rectocoele.

Minimally invasive ventral mesh rectopexy for complex rectocoele offers satisfactory anatomical correction and functional results, with the potential for alleviating symptoms of outlet obstruction and improving vaginal comfort and sexual dysfunction.

Assessment of sexual function is accepted by the majority of patients suffering from pelvic floor disorders. In addition to the benefit on anatomical restoration and bowel function, LVR improves sexual function and dyspareunia in patients operated on for complex rectocoele.

Background. There are little reliable data regarding the rate of recurrence after incisional hernia repair (IHR). The French Society of Surgery (AFC) has endorsed a cohort aiming to prospectively assess the frequency of recurrence after IHR and to identify the risk factors. Methods. Consecutive patients undergoing IHR in the participating centers were included in the prospective AFC cohort over a 6-month period. Patients were followed up with a CT-scan at 1 year and a clinical assessment by the surgeon at 2 years. We collected patient characteristics, medical history, and information regarding hernias and the surgical technique for the analysis of recurrence. Results. A total of 1075 patients undergoing IHR were included in 61 participating centers. The median follow-up was 24.0 days [IQR: 14.0-25.3]. The follow-up rates were 83.0% and 68.5% at 1 and 2 years, respectively. The recurrence rates were 18.1% at 1 year and 27.7% at 2 years. In multivariate analysis, risk factors associated with 1-year recurrence were a history of hernia (OR = 1.51, 95% CI = 1.01-2.27, p = 0.045), a concomitant digestive surgery (OR = 1.81, 95% CI = 1.09-3.01, p = 0.022) and the occurrence of early surgical site complications (OR = 2.06, 95% CI = 1.15-3.69, p = 0.015). Recurrence risk factors at 2 years were a history of hernia (OR = 1.57, 95% CI = 1.05-2.35, p = 0.028), a lateral hernia (OR = 1.84, 95% CI = 1.19-2.86, p = 0.007), a concomitant digestive surgery (OR = 1.97, 95% CI = 1.20-3.22, p = 0.007) and the occurrence of early surgical site complications (OR = 1,90, 95% CI = 1.06-3.38, p = 0.030). The use of surgical mesh was strongly associated with a lower risk of recurrence at 2 years (p<0.001). Conclusion. After incisional hernia repair, the 2-year recurrence rate is as high as 27.7%. History of hernia, lateral hernia, concomitant digestive surgery, the onset of surgical site complications and the absence of mesh are strong risk factors for recurrence.

Our results highlight immunosuppressive drug intake as a major risk factor for laparoscopic peritoneal lavage failure in patients who have Hinchey III diverticulitis. Immunosuppression and severe comorbidities (ASA ≥3) should be considered when selecting a surgical option in patients with Hinchey III diverticulitis. See Video Abstract at http://links.lww.com/DCR/A423.