Current status of laparoscopic and robotic ventral mesh rectopexy for external and internal rectal prolapse

Abstract

External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy (VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented.

Adverse obstetric history is not a risk factor for poor outcome after ventral rectopexy for obstructive defaecation syndrome

“…The patients undergoing VMR in this study demonstrated a significant improvement in defaecation with 76% experiencing improvement in ODS symptoms. This falls into the 55-86% range cited by van Iersel et al [10].…”

An expert consensus definition of failure of a treatment to provide adequate relief (F‐PAR) for chronic constipation – an international Delphi survey

“…Although diagnostic criteria have existed for some time for functional gastrointestinal disorders, establishing the correct diagnosis and identifying aetio‐pathogenesis of CC are key first steps required to optimise the clinical outcome for the patient. As new research has provided a better understanding of the range of primary and secondary causes of CC, so it has also identified new targets for physical and pharmacological treatment of the disease . With new behavioural, pharmacological and surgical treatments becoming available it is essential to recognise when a treatment is failing to work adequately and thus should be switched.…”

The use of polymeric meshes for pelvic organ prolapse: Current concepts, challenges, and future perspectives

“…However, based on the outcomes from medical practice, the use of surgical meshes for the management of both SUI and POP is accompanied by benefits but also risks (Barber, ), which in some cases can lead to serious life‐threating conditions, as will be discussed in the following paragraphs (Falagas, Velakoulis, Iavazzo, & Athanasiou, ; Keys, Campeau, & Badlani, ; van Iersel et al, ; Wu, ).…”