“Wrap technique”: a new operative procedure using a self-adhesive prosthesis for laparoscopic ventral rectopexy

Abstract

The aim of the present study was to describe and assess a new method of fixation using a self-adhesive prosthesis (Adhesix(™)) in laparoscopic ventral rectopexy (LVR). The technical principles are based on a very low dissection and the adhesive properties of the prosthesis which can be applied to the rectum without stitches or staples. The prosthesis is made from polypropylene coated with a synthetic hydrogel. The binding of the prosthesis to rectum and vagina takes place in a wet environment after a few minutes and enables the shaping of the mesh on the surface of the rectum (wrap effect). Between March 2010 and March 2013, 41 patients were operated on using LVR with a self-adhesive prosthesis. The effectiveness of prosthesis fixation was evaluated in a subset of 27 patients suffering from complete rectal prolapse. With a median follow-up of 30 months, there were no major complications and no recurrence. In this initial experience, LVR with a self-adhesive prosthesis does not increase the risk of recurrence. No undesirable effects were associated with the prosthesis.

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

“…There were 38 studies reporting the outcome of the use of mesh with rectopexy [13‐51] and one study reporting the outcome of resection suture rectopexy [45]. It was not possible to estimate the effect from pooled data in GRADE evidence due to lack of a comparator in all studies and one non‐mesh study with 0% recurrence.…”

Surgery for constipation: systematic review and practice recommendations

“…From these, 18 articles published between 1995 and 2015 contributed to the systematic review, providing data on outcomes in a total of 1238 patients (range 20-233 patients per study) based on 18 defined patient cohorts (Table 1). Specific exclusions after full-text review (and after exclusion of non-English language publications) included 4 studies where the population sample was confirmed to be less than 20 patients [5,[36][37][38], 4 studies of out-of-scope procedures [9-11,39], 2 studies where data were considered a duplicate [34,40], and 10 studies where outcomes could not be segregated by eligible procedure; [12][13][14][15][16][17][18][19][20][21] other exclusion criteria were: constipation not representing an indication (n = 2) [32,41], follow-up less than 12 months (n = 5) [8,33,35,42,43], and lack of primary patient data (one international survey on 391 surgeons) [44].…”

“…laparoscopic promonto-fixation [11]. Studies where outcomes could not be segregated by eligible procedure were also excluded due to a mixed patient population with internal and external rectal prolapse [12][13][14][15][16][17][18][19], mixed indications including numerous pelvic floor abnormalities [20] or limited postoperative outcomes [21].…”

“…These ligaments contain nerves to the rectal wall and the resultant denervation may be the cause. In the process of developing alternative resuspending procedures, surgeons have attempted to limit the effect of the foreign material by using sutures only [5], added a resection of the sigmoid colon to the rectopexy [6][7][8] or more recently, limiting the dissection of the rectum to the ventral surface by supporting the rectum with mesh [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. In addition, laparoscopy has become the favoured approach procedurally, not only allowing a more rapid recovery but also easing access to, and visibility in the pelvis.…”

Wrap technique for rectal prolapse: video step by step

“…The risk of mesh detachment is present, but limited [1]. Moreover, the procedure is made easier and faster by the lower number of sutures needed.…”