Introduction Ventral mesh rectopexy (VMR) is a recognised treatment for posterior compartment pelvic organ prolapse (POP). A variety of synthetic meshes have been used for a wide range of POP surgery but there have been reports of high rates of pelvis sepsis, as well as concerns regarding mesh erosion, dyspareunia, fistulation and stricturing. It has been postulated that biological mesh may cause fewer complications in comparison to synthetic mesh in certain high-risk circumstances. The aim of this review is to provide a synopsis of the evidence for biologic mesh use in VMR, the most widely recognised surgical technique for posterior compartment POP.
Method A systematic search of PubMed was conducted using the search terms ‘VMR’, ‘ventral mesh rectopexy’ or ‘mesh rectopexy’. Inclusion criteria were studies that described a ventral rectopexy using a biological mesh in either an open or laparoscopic technique. Studies were excluded if only synthetic mesh was used or if there was no mention of a mesh. Furthermore, studies on patients under the age of 18 were excluded as well as non-English language studies, technical tips or duplicates series from the same research group. Overall, the search yielded 6 studies for analysis after the exclusion of review articles.
Results From 6 case series, 268/324 patients underwent ventral rectopexy using biological mesh with a further 6 patients having a combination of synthetic mesh and biological mesh. Overall, 155 patients underwent VMR using additionally cross-linked porcine dermal collagen (PermacolTM or PelvicolTM) and 89 using porcine intestinal submucosa (Surgisis©). Recurrence was reported in 20 patients; however, 6 of these were from studies where data on biological mesh could not be extracted. One study did not report recurrence.
There are no randomised controlled trials in VMR surgery generally and no studies have directly compared types of biologic mesh e.g. cross-linked vs.non-cross-linked. Cross-linked porcine dermal collagen is the most commonly used mesh and has not been associated with mesh erosion, infection or fistulation in this current review. The level of evidence available on the use of biologic mesh in VMR is of low quality (level 4).
Conclusion VMR has become prevalent for posterior compartment POP. The evidence base for its implementation is not strong and the quality of evidence to inform choice of mesh is poor.
Disclosure of interest None Declared.
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