Failure Following Laparoscopic Ventral Mesh Rectopexy

摘要

Laparoscopic ventral mesh rectopexy (LVMR) is the standard option for the first-line treatment of rectal prolapse but also rectocele. A limited rectal dissection decreases the morbidity rate and nerve injury that often occurred in an extensive dissection. Thus, functional results have been improved without increasing recurrence rate. Despite a high success rate, some patients will experience recurrence. Studies report a wide range of recurrence between 2 and 20%. In terms of functional results, improvement can vary for each patient and no predictive factors for recurrence have been. Routinely, when facing a failure of LVMR the surgeon should first try to find an explanation for failure (technical or patient related factor); Secondly, to assess the patient's complaints and the history of the recurrence. Finally, treatment option should be offered to the patient and obvious information must be delivered for informed consent. The results of redo surgery seem to be fair with no significant increase of morbidity rate. Larger cohorts and randomized studies are mandatory to improve the level of evidence for redo surgery in pelvic floor disorders.