Synthetic or biological mesh use in laparoscopic ventral mesh rectopexy - a systematic review

Aim Laparoscopic ventral mesh rectopexy (VMR) is a surgical option for internal and external rectal prolapse with low perioperative morbidity and low recurrence rates. Use of synthetic mesh in the pelvis may be associated with complications such as fistulation, erosion and dyspareunia. Biological meshes may avoid these complications, but the long-term outcome is uncertain. Debate continues as to which type of mesh is optimal for laparoscopic VMR. Method A literature search was performed of electronic databases including MEDLINE, Embase and Scopus (2000-12). Studies describing outcomes relating to the mesh were included for review. Only English language studies were included. Results Thirteen observational studies reported the outcome of 866 patients following laparoscopic VMR. Eleven reported the outcome using synthetic mesh with a median follow-up ranging from 7 to 74months. Two studies reported the outcome with biological mesh with a median follow-up of 12months. Pooled analysis of the studies demonstrated that 767 patients had a repair with synthetic mesh and 99 with a biological implant. There was no difference in recurrence (3.7 vs 4.0%, P=0.78) or mesh complications (0.7 vs 0%, P=1.0%) between synthetic and biological mesh repair. Conclusion Biological meshes appear to be as effective as synthetic meshes in the short term for laparoscopic VMR. Mesh complication rates are low in both groups. Long-term follow-up is required to ascertain if these findings persist.