European Society of Coloproctology guidance on the use of mesh in the pelvis in colorectal surgery

Maeda, Yasuko; Espín‐Basany, Eloy; Gorissen, K.; Kim, Mia; Lehur, P.‐A.; Lundby, Lilli; Negoi, Ionuț; Norčič, Gregor; O'Connell, P. R.; Rautio, Tero; Geluwe, Bart Van; Ramshorst, Gabriëlle H. van; Warwick, Andrea; Vaizey, C. J.

doi:10.1111/codi.15718

Cited by 15 publications

(15 citation statements)

References 139 publications

(611 reference statements)

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“…Most available guidance on using mesh in colorectal surgery lack high-quality data derived from randomized clinical trials, contains significant heterogeneity in the indications, and failed to report complications (22). Nevertheless, except for one minor adverse outcome (local inflammation), we observed no complications in the present study.…”

Section: Discussioncontrasting

confidence: 59%

Ventral Pelvio-anal Reconstruction as a Variation of Established Surgical Management of Severe and Refractory Fecal Incontinence: A Case Series Study

Pakravan¹,

Safarpour

Poschinski³

et al. 2022

Shiraz E-Med J

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Background: Conventional treatments may not be effective in some severe cases of fecal incontinence (FI). Objectives: In the present study, we evaluated the applicability of ventral pelvio-anal reconstruction (VPAR) as a modified operative technique for 17 patients with severe and refractory FI. Methods: We performed VPAR by placing a mesh in the perineum and securing it at the sacrospinal ligament on both sides. The Cleveland Clinic Incontinence Score (CCIS) and Fecal Incontinence Quality of Life (FIQoL) questionnaires were completed by the patients, and anorectal manometry was performed before and after the operation (3,6 and 12 months), and the results were compared against the baseline values. Results: The operation was successful in all patients; no mesh was explanted during the follow-up period, and all patients reported satisfactory outcomes. Postsurgical anorectal manometry showed an increase in both rest and squeeze pressures. The CCIS decreased while the FIQoL increased significantly during the first-year follow-up (P < 0.001). Conclusions: By incorporating the implant into the perineal body, we hypothesized that our combined technique would lead to favorable outcomes, and the preliminary results confirmed this. Further studies with larger patient populations and more extended follow-up periods are needed to confirm our satisfactory results and conclude that the VPAR approach is a safe and appropriate therapeutic option for patients with severe and refractory FI.

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Section: Discussioncontrasting

confidence: 59%

Ventral Pelvio-anal Reconstruction as a Variation of Established Surgical Management of Severe and Refractory Fecal Incontinence: A Case Series Study

Pakravan¹,

Safarpour

Poschinski³

et al. 2022

Shiraz E-Med J

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“…In current practice, the benefits of minimally invasive surgery are realised in rectopexy including improved pain control, shorter length of stay and shorter return of bowel function with comparable recurrence rates. As a result, surgical societies have recommended laparoscopy as the gold standard where resources and expertise are available [26][27][28][29][30][31]. Robotic surgery is a more recent minimally invasive approach applied to rectopexy and to date there have been few high-quality studies comparing the techniques [13,[32][33][34][35].…”

Section: Discussionmentioning

confidence: 99%

Using a modified Delphi process to explore international surgeon-reported benefits of robotic-assisted surgery to perform abdominal rectopexy

Keating

Brannigan²,

Balla³

et al. 2022

Tech Coloproctol

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Background Robotic-assisted surgery (RAS) offers improved visualisation and dexterity compared to laparoscopy. As a result, RAS is considered an attractive option for performing rectopexy, particularly in the confines of the lower pelvis. The aim of this study was to explore the benefits of RAS in rectopexy by analysing the views of a group of surgeons will have published on robotic rectopexy. Methods A three-round Delphi process was performed. Combined qualitative, Likert scale and binary responses were utilised in rounds one and two with binary responses seeking overall consensus in round two and three. Particular areas that were studied included: clinical aspects of patient selection, technical aspects of using RAS to perform rectopexy, ergonomic factors, training, and consideration of the 'learning-curve'. Consensus was defined as agreement > 80% among participants. Potential experienced RAS rectopexy surgeons were identified using PubMed where authors of studies reporting outcomes from RAS rectopexy were searched and invited. Results Twenty surgeons participated from the following countries:

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“…Opinions are often reached without properly limiting supporting data to rectal prolapse with the mesh placed through the abdominal wall, rather than pelvic organ prolapse or stress urinary incontinence with transvaginal mesh placement. Mesh is not contraindicated for rectal prolapse, but requires proper patient selection, mesh selection, knowledge of the anatomy and compartments affected, thorough patient education, and treatment by surgeons with specialized training who are working in multidisciplinary referral centres [11,12]. It also has implications in the ability to use certain mesh products 'on label' for repair.…”

Section: E D I T O R I a L Is Rectal Prolapse A Hernia?mentioning

confidence: 99%

Is rectal prolapse a hernia?

Keller

Smart

2022

Colorectal Disease

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European Society of Coloproctology guidance on the use of mesh in the pelvis in colorectal surgery

Abstract: This is a comprehensive and rigorous review of currently available data on the use of mesh in the pelvis in colorectal surgery. This guideline outlines the limitations of available data and the challenges of interpretation, followed by best possible recommendations.

Cited by 15 publications

References 139 publications

Ventral Pelvio-anal Reconstruction as a Variation of Established Surgical Management of Severe and Refractory Fecal Incontinence: A Case Series Study

Ventral Pelvio-anal Reconstruction as a Variation of Established Surgical Management of Severe and Refractory Fecal Incontinence: A Case Series Study

Using a modified Delphi process to explore international surgeon-reported benefits of robotic-assisted surgery to perform abdominal rectopexy

Is rectal prolapse a hernia?

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