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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
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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)