Biologic mesh extrusion months after laparoscopic ventral rectopexy: reasons and consequences

Techniques in Coloproctology, Jan 2017

S. H. Emile

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Biologic mesh extrusion months after laparoscopic ventral rectopexy: reasons and consequences

Biologic mesh extrusion months after laparoscopic ventral rectopexy: reasons and consequences S. H. Emile 0 Dear Sir 0 0 Department of General Surgery (8), Faculty of Medicine, Mansoura University Hospital, Mansoura University , Mansoura 35516 , Egypt - I have read with great interest the report by Sileri et al. [1] recently published in Techniques in Coloproctology. This interesting report sheds light on a rare and unique complication of laparoscopic ventral rectopexy using biologic mesh: the spontaneous extrusion of the mesh after the procedure [2]. However, I have a few queries regarding points that were not clarified in the manuscript. First, although the report clearly described the details of the surgical technique and the clinical presentation of the patient after mesh extrusion, the possible reasons for such complication were not discussed. In figure 1, the mesh appeared to be completely intact with disruption of all anchoring sutures and tacks, and one wonders what mechanism caused the mesh to completely detach from the rectum and get extruded in such a way. A plausible reason for this complication could be failure of physiological adhesions to form between the mesh and rectum. If no adhesions had developed to integrate and fix the mesh to the rectum, then the sutures would be of little value on their own in retaining the mesh in place. Mesh must integrate into the body in order to achieve permanent repair. This integration starts with an inflammatory reaction, followed by cellular and vascular infiltration and finally matrix remodeling. If this response was exaggerated, it could lead to excessive scaring and degradation of the mesh. On the other hand, with suboptimal foreign body response, which sometimes occurs with biologic meshes, failure of integration of the mesh can occur and eventually extrusion of the mesh [3]. Another important point that the report did not emphasize was the clinical outcome of the patient after mesh extrusion. Although the authors stated that the patient had no constipation for up to one year after mesh extrusion, no mention of further assessment for recurrence of the internal rectal prolapse either by clinical examination or evacuation proctography was made. Furthermore, if the patient was symptom-free and the internal prolapse did not recur in the absence of the mesh, which is supposed to be the main factor preventing the recurrence of the prolapse, then the following question should be asked: what maintained the clinical improvement of the patient for an entire year after mesh extrusion. Compliance with ethical standards Ethical approval This article does not contain any studies with human participants or animals by any of the authors. 1. Sileri P , Shalaby M , Orlandi A ( 2016 ) Biological mesh extrusion months after laparoscopic ventral rectopexy . Tech Coloproctol. doi:10.1007/s10151-016-1561-0 2. Smart NJ , Pathak S , Boorman P , Daniels IR ( 2013 ) Synthetic or biological mesh use in laparoscopic ventral mesh rectopexy-a systematic review . Colorectal Dis 15 : 650 - 654 3. FitzGerald JF , Kumar AS ( 2014 ) Biologic versus Synthetic Mesh Reinforcement: What are the Pros and Cons? Clin Colon Rectal Surg 27 : 140 - 148 (...truncated)


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S. H. Emile. Biologic mesh extrusion months after laparoscopic ventral rectopexy: reasons and consequences, Techniques in Coloproctology, 2017, pp. 321, Volume 21, Issue 4, DOI: 10.1007/s10151-016-1579-3