Laparoscopic Rectopexy with Urinary Bladder Xenograft Reinforcement

Abstract

Background and Objectives:Rectal prolapse is often repaired laparoscopically, frequently with the use of reinforcement material. Both synthetic and biologically derived materials reduce recurrence rate compared to primary suture repair. Synthetic mesh introduces potential complications such as mesh erosion, fibrosis, and infection. Urinary bladder matrix (UBM) represents a biologically derived material for reinforcement of rectal prolapse repair with the potential to improve durability without risks of synthetic materials. The objective of the study is to evaluate the effectiveness, durability, and functional result of laparoscopic rectopexy using urinary bladder matrix xenograft reinforcement at three years follow up.Methods:The 20 cases presented describe rectal prolapse repair by means of laparoscopic rectopexy with presacral UBM reinforcement. Patients were followed up for an average of 3 years and assessed with interviews, physical examination, manometry, and the fecal incontinence severity index (FISI).Results:Each repair was completed laparoscopically. UBM exhibited favorable handling characteristics when sutured to the sacrum and the lateral rectal walls. One patient underwent laparoscopic drainage of a postoperative abscess; no other complications occurred. In 3 years of follow-up, there have been no full-thickness recurrences, erosions, reoperations, or long-term complications. Two patients exhibited a small degree of mucosal prolapse on follow-up physical examination that did not require surgery. Three-year FISI scores averaged 8 (range, 0–33 of a possible 61), indicating low fecal incontinence symptomatology. Follow-up anorectal manometry was performed in 9 patients, showing mixed results.Conclusion:Surgeons may safely use laparoscopic rectopexy with UBM reinforcement for repair of rectal prolapses. In this series, repairs with UBM grafts have been durable at 3-year follow-up and may be an alternative to synthetic mesh reinforcement of rectal prolapse repairs. Future studies may compare the advantages and cost-effectiveness of reinforcement materials for rectal prolapse repair.

Comparison of in Vivo Remodeling of Urinary Bladder Matrix and Acellular Dermal Matrix in an Ovine Model

“…The results of this study for UBM shed light on, and support, clinical publications that have also shown successful outcomes when using UBM surgical devices in the reinforcement of various hernia repairs [50][51][52][53][54]. In combination, these studies suggest that UBM devices present a low risk of complications in the immediate post-operative period due to the timing of resorption, while the long-term recurrence rates appear to be relatively low, suggesting that robust connective tissue replaces the UBM as it is resorbed.…”

Retrorectus Repair of Incisional Ventral Hernia with Urinary Bladder Matrix Reinforcement in a Long-Term Porcine Model

“…Clinical case studies that utilized commercialized versions of MatriStem UBM™ for wound management (i.e., Cytal R Wound Matrix and MicroMatrix R ; ACell Inc., MD, USA) have also shown that UBM can support deposition of granulation tissue and re-epithelialization in a variety of challenging applications, such as complex traumatic wounds, contaminated wounds and wounds with exposed avascular structures [25][26][27]. Similarly, there is growing evidence for the successful clinical use of UBM in various surgical reinforcement applications [28,29].…”

Long-term clinical, radiological, and histological follow-up after complex ventral incisional hernia repair using urinary bladder matrix graft reinforcement: a retrospective cohort study

“…UBM has demonstrated effectiveness in a variety of anatomic settings in humans including hiatal hernia repair, rectal prolapse repair, esophageal wall repair, and abdominal wall repair [ 16 , 17 , 27 ]. While UBM undergoes a biodegradation process, it is believed that site-appropriate tissue is deposited and remodels to support the local physiologic loads as the UBM device is resorbed.…”

“…Case reports of successful reinforcement of fascial defects in humans using UBM have provided anecdotal evidence that the remodeling process may result in the deposition of site-appropriate tissue that may provide sufficient strength and durability as to render the fascial defect effectively repaired and successfully avert further surgery. UBM reinforcement has proven durable in parastomal hernia repair, rectal prolapse repair, and hiatal hernia repair with follow-up ranging from 24 to 36 months on average [ 16 , 17 ].…”