Is mesh related morbidity the real thread in ventral rectopexy? Results of a retrospective international multicentre comparative analysis of biologic versus synthetic mesh

Aim: Ventral mesh rectopexy (VMR) is an established surgical treatment for rectal prolapse and outlet obstruction. In contrast to continental Europe, in the UK and US the use of synthetic mesh has been abandoned in favour of biologic mesh, due to concerns regarding mesh related morbidity. The current study investigated if either material is superior, in terms of clinical recurrence and mesh related complications. Methods: VMRs performed between March 2012 and July 2022 in three international pelvic floor centres were prospectively collected and retrospectively analysed, to look at the rate of complications and need for further therapy, including reoperation. Results: A total of 360 patients were included in the study (140 biologic mesh (bm) / 220 synthetic mesh (sm)). Postoperative complication occurred in 5.7% in bmVMR (5% minor [Clavien-Dindo I and II] and 0.7% major [Clavien-Dindo > = III]) and in 10.9% in smVMR (9.1% minor and 1.8% major) (p = 0.28). Oral laxatives were necessary in 31% after bmVMR and in 35% after smVMR (p = 0.49). Rectal laxatives were used in 11% after bmVMR and in 7% after smVMR (p = 0.34). Clinical recurrence appeared in 9% bmVMR and in 5% smVMR (p = 0.20). Mean time to clinical recurrence in bmVMR was 20.9 (5 to 58) months and in smVMR 20.2 (0-55) months (p = 0.75). Mean overall follow-up time was 18.4 (0-96) months. Reoperation rate due to clinical recurrence was 6.11% in the bmVMR group versus 2.75% in the smVMR group (p = 0.16). No mesh associated complications such as symptomatic erosion or fistulation occurred in either group. Conclusion: VMR using biologic mesh was equally safe to that using synthetic mesh, with no difference in clinical recurrence rate. No mesh-associated morbidity was observed in either group.