Ventral mesh rectopexy for recurrent rectal prolapse after Altemeier perineal proctosigmoidectomy: feasibility and outcomes

Lukas Schabl; Tracy Hull; Kamil Erozkan; Ali Alipouriani; Kristen A Ban; Scott R Steele; Anna R Spivak

doi:10.1007/s00423-024-03227-w

Ventral mesh rectopexy for recurrent rectal prolapse after Altemeier perineal proctosigmoidectomy: feasibility and outcomes

Langenbecks Arch Surg. 2024 Feb 2;409(1):49. doi: 10.1007/s00423-024-03227-w.

Authors

Lukas Schabl¹, Tracy Hull¹, Kamil Erozkan¹, Ali Alipouriani¹, Kristen A Ban¹, Scott R Steele¹, Anna R Spivak²

Affiliations

¹ Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA.
² Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA. spivaka2@ccf.org.

Abstract

Purpose: Recurrence of rectal prolapse following the Altemeier procedure is reported with rates up to 40%. The optimal surgical management of recurrences has limited data available. Ventral mesh rectopexy (VMR) is a favored procedure for primary rectal prolapse, but its role in managing recurrences after Altemeier is unclear. VMR for recurrent prolapse involves implanting the mesh on the colon, which has a thinner wall, more active peristalsis, no mesorectum, less peritoneum available for covering the mesh, and potential diverticula. These factors can affect mesh-related complications such as erosion, migration, or infection. This study assessed the feasibility and perioperative outcomes of VMR for recurrent rectal prolapse after the Altemeier procedure.

Methods: We queried our prospectively maintained database between 01/01/2008 and 06/30/2022 for patients who had experienced a recurrence of full-thickness rectal prolapse following Altemeier's perineal proctosigmoidectomy and subsequently underwent ventral mesh rectopexy.

Results: Ten women with a median age of 67 years (range 61) and a median BMI of 27.8 kg/m² (range 9) were included. Five (50%) had only one Altemeier, and five (50%) had multiple rectal prolapse surgeries, including Altemeier before VMR. No mesh-related complications occurred during a 65-month (range 165) median follow-up period. Three patients (30%) experienced minor postoperative complications unrelated to the mesh. Long-term complications were chronic abdominal pain and incisional hernia in one patient, respectively. One out of five (20%) patients with only one previous prolapse repair had a recurrence, while all patients (100%) with multiple prior repairs recurred.

Conclusion: Mesh implantation on the colon is possible without adverse reactions. However, high recurrence rates in patients with multiple previous surgeries raise doubts about using VMR for secondary or tertiary recurrences.

Keywords: Altemeier; Proctosigmoidectomy; Rectal prolapse; Recurrence; Ventral mesh rectopexy.

MeSH terms

Aged
Feasibility Studies
Female
Humans
Laparoscopy* / methods
Middle Aged
Neoplasm Recurrence, Local / surgery
Rectal Prolapse* / surgery
Rectum / surgery
Recurrence
Surgical Mesh
Treatment Outcome