Long-term Outcomes After Minimally Invasive Ventral Rectopexy for Rectal Prolapse Using Biologic Graft Prosthesis: A 15-Year Retrospective Cohort Study.

Abstract

Background: Minimally invasive ventral rectopexy has widely become the preferred prolapse procedure. However there have been recent concerns regarding the safety of permanent synthetic mesh in the pelvis. Biologic grafts have also been commonly used as an alternative prosthesis, but data on their safety and the longevity of the prolapse repair have been lacking.

Objective: To assess the short and long-term safety and efficacy of biologic grafts in minimally invasive ventral rectopexy.

Design: Retrospective cohort study using data from a prospectively collected database.

Settings: Single surgeon at a single tertiary hospital in Australia.

Patients: There were 366 patients with minimum 6 months follow-up undergoing minimally invasive ventral rectopexy using a biologic graft between January 1, 2008, and October 5, 2023.

Main outcome measures: Overall recurrence, complications and functional outcomes.

Results: A total of 57 patients (15.6%, n = 57) experienced a recurrence during the study period, with a median follow up time of 35.5 months (range, 6-183 months). Of these, 17 (4.6%) were full thickness recurrence. The Kaplan-Meier estimates of the overall 1-, 3-, and 5-year recurrence rates were 2.0%, 6.0% and 16.0% respectively. There was no statistically significant difference in recurrence for patients who presented with a full thickness prolapse compared to those with other indications (16.8% vs 14.2%, p=0.29). Overall, there were a total of 34 complications which occurred in 29 (7.9%) patients. 19 patients (5.2%) required a return to theatre. There were no graft related complications or long-term pelvic pain. 98% of patients had symptomatic improvement and were satisfied with their outcome.

Limitations: Retrospective study and generalizability of the results from single surgeon experience. Late recurrences may have been missed.

Conclusions: Minimally invasive ventral rectopexy using a biological graft is both safe and effective, offering acceptable short- and long-term recurrence rates and overall complications with no graft related morbidity. See Video.