Annals of Coloproctology

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Original Article

Anorectal physiology & pelvic floor disorder

Laparoscopic ventral mesh rectopexy with and without transverse perineal support using biological mesh for rectal prolapse and perineal descent: postoperative course and functional outcomes: Maria Clelia Gervasi, Giorgio Brancato, Lorenzo Crepaz, Ahmad Tfaily, Alberto Di Leo; Ann Coloproctol. 2025;41(5):453-461. Published online October 28, 2025; DOI: https://doi.org/10.3393/ac.2025.00080.0011

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Abstract PDF Supplementary Material: Purpose
Laparoscopic ventral mesh rectopexy (LVMR) is effective for the treatment of rectal prolapse. However, descending perineal syndrome may impair the outcomes of LVMR. The aim of this study was to assess the safety and functional outcomes of LVMR performed with and without transverse perineal support (TPS).
Methods
This was a retrospective study of 143 consecutive female patients treated with LVMR with or without TPS between 2018 and 2022. Patients with rectal prolapse and perineal descent who underwent surgery were included. Obstructed defecation syndrome and fecal incontinence were evaluated using the Cleveland Constipation Score (Wexner score) and St. Mark’s Incontinence Score, respectively. Perineal descent was defined using defecography. Biological meshes were utilized in all cases.
Results
No significant differences were recorded between with- and without-TPS groups at baseline. TPS was performed in 110 patients (76.9%). Surgical morbidity was higher in the with-TPS group (12.7% vs. 0%, P=0.047), primarily due to seroma formation. Almost all complications were mild (Clavien-Dindo grades I–II). In both groups, digital aid for defecation (P<0.001), prolonged straining (P=0.004), and hematochezia (P<0.001) nearly disappeared postoperatively, though constipation and laxative/enema use persisted in 22.4%. Fecal incontinence significantly decreased from 43.4% to 11.2% (P<0.001). TPS appears to have a potentially favorable effect in reducing the constipation score. Both constipation and incontinence scores remained low up to 24 months after surgery. Operative time was significantly longer in the LVMR with-TPS group (P<0.001).
Conclusion
LVMR with TPS appears safe and feasible. TPS may provide better surgical outcomes compared to LVMR alone for patients with symptomatic rectoceles and descending perineum syndrome.

Case Report

Benign GI diease,Complication

Transmural Mesh Migration From the Abdominal Wall to the Rectum After Hernia Repair Using a Prolene Mesh: A Case Report: Yujin Lee, Byung-Noe Bae; Ann Coloproctol. 2021;37(Suppl 1):S28-S33. Published online May 15, 2020; DOI: https://doi.org/10.3393/ac.2020.04.19

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8 Citations

Abstract PDF

Mesh erosion or migration is a rare and late complication after hernia repair. Its incidence is increasing as the utilization of prosthetic mesh gains popularity for abdominal hernia repair. However, mesh migration is exceedingly rare and its clinical presentation is atypical and diverse. Therefore, the management of mesh migration should be individualized to each patient. This research reports the case of a 94-year-old man with transmural migration of Prolene mesh (Ethicon) from the abdominal wall to the rectum 14 years after incisional hernia repair. He presented with only chronic abdominal pain and constipation. Migration of the mesh and a fistula between the right abdominal wall and transverse colon was observed on computed tomography. The mesh was evacuated manually from the anus without any sequelae. These findings made this case atypical, since complete transluminal migration of mesh is exceedingly rare and mesh erosion or migration requires surgical treatment in many cases.

Citations

Citations to this article as recorded by

Clinical Insights and Brief Research Report on Mesh Erosion Into Bowel Following Hernia Repair: A Single-Centre Series of Eight Cases
Vidit Dholakia, Suvendu Sekhar Jena, Amitabh Yadav, Samiran Nundy
Journal of Abdominal Wall Surgery.2025;[Epub] CrossRef
An unlikely path: hernia mesh migration
Ana Rita Ferreira, Bárbara Castro, Catarina Ortigosa, Sílvia Costa, Bela Pereira, Manuel Oliveira
European Surgery.2024; 56(1-2): 39. CrossRef
Spontaneous Migration of Intraperitoneal Mesh into Rectum following Ventral Hernia Repair
Aruna R. Patil, Ravishankar Bhat, Madhusudhana Basavarajappa
Journal of Gastrointestinal and Abdominal Radiology.2023; 06(01): 053. CrossRef
Gastrocutaneous fistula caused by mesh migration following diaphragmatic rupture repair
Yuan Zhang, Jun Peng, Xingui Wu, Dingjiao Zhu, Yaozhi Chen
ANZ Journal of Surgery.2023; 93(4): 1042. CrossRef
Enterocutaneous fistula from a mesh eroding the small bowel after incisional hernia repair
Michael L. Lorentziadis, Moustafa Mahmoud Nafady Hego, Fatma Al Nasser
International Journal of Abdominal Wall and Hernia Surgery.2023; 6(1): 48. CrossRef
Does intraperitoneal mesh increase the risk of bowel obstruction? A nationwide French analysis
Théophile Delorme, Jonathan Cottenet, Fawaz Abo-Alhassan, Alain Bernard, Pablo Ortega-Deballon, Catherine Quantin
Hernia.2023; 28(2): 419. CrossRef
A Cecal Surprise
Muhammad B. Hammami, Jean-Pierre Raufman
Gastroenterology.2022; 162(7): 1847. CrossRef
Mesh on the move: a case report of total transmural surgical mesh migration causing bowel obstruction
Joseph Ryan Leach, Bryan Manoukian, Lygia Stewart
Clinical Journal of Gastroenterology.2021; 14(1): 136. CrossRef

Original Article

Laparoscopic Posterolateral Rectopexy for the Treatment of Patients With a Full Thickness Rectal Prolapse: Experience With 63 Patients and Short-term Outcomes: Keehoon Hyun, Shi-Jun Yang, Ki-Yun Lim, Jong-Kyun Lee, Seo-Gue Yoon; Ann Coloproctol. 2018;34(3):119-124. Published online June 30, 2018; DOI: https://doi.org/10.3393/ac.2018.01.31

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184 Download
5 Web of Science
5 Citations

Abstract PDF

Purpose
Although numerous procedures have been proposed for the treatment of patients with a rectal prolapse, the most effective operation has not yet been established. Minimal rectal mobilization can prevent constipation; however, it is associated with increased recurrence rates. We describe our novel method for a laparoscopic posterolateral rectopexy, which includes rectal mobilization with a posterior-right unilateral dissection, suture fixation to the sacral promontory with a polypropylene mesh (Optilene), and a mesorectal fascia propria that is as wide as possible. The present report describes our novel method and assesses the short-term outcomes of patients.
Methods
Between June 2014 and June 2017, 63 patients (28 males and 35 females) with a full-thickness rectal prolapse underwent a laparoscopic posterolateral (LPL) rectopexy. We retrospectively analyzed the clinical characteristics and postoperative complications in those patients. The outcome of surgery was determined by evaluating the answers on fecal incontinence questionnaires, the results of anal manometry preoperatively and 3 months postoperatively, the patients’ satisfaction scores (0–10), and the occurrence of constipation.
Results
No recurrence was reported during follow-up (3.26 months), and 3 patients reported postoperative complications (wound infection, postoperative sepsis, which was successfully treated with conservative management, and retrograde ejaculation). Compared to the preoperative baseline, fecal incontinence at three months postoperatively showed an overall improvement. The mean patient satisfaction score was 9.55 ± 0.10, and 8 patients complained of persistent constipation.
Conclusion
LPL rectopexy is a safe, effective method showing good functional outcomes by providing firm, solid fixation for patients with a full-thickness rectal prolapse.

Citations

Citations to this article as recorded by

Anatomical and functional outcomes of rectal prolapse treatment with laparoscopic pelvic organ prolapse suspension versus laparoscopic ventral mesh rectopexy
Adel Zeinalpour, Alimohammad Bananzadeh, Mohammad Mostafa Safarpour, Sara Shojaei‐Zarghani, Seyede Saeideh Shahidinia, Seyed Vahid Hosseini, Ali Reza Safarpour
Surgical Practice.2025; 29(1): 26. CrossRef
Surgical outcomes on health-related quality of life in rectal prolapse: A systematic review and meta-analysis
Hannaneh Yousefi-Koma, Yassin Rahnama, Dorsa Najari, Fatemeh Fathabadi, Mojtaba Sedaghat, Alireza Kazemeini, Mohammad Reza Keramati, Amir Keshvari, Mohammad Sadegh Fazeli, Behnam Behboudi, Seyed Mohsen Ahmadi-Tafti
Techniques in Coloproctology.2025;[Epub] CrossRef
Clinical outcomes of surgical management for recurrent rectal prolapse: a multicenter retrospective study
Kwang Dae Hong, Keehoon Hyun, Jun Won Um, Seo-Gue Yoon, Do Yeon Hwang, Jaewon Shin, Dooseok Lee, Se-Jin Baek, Sanghee Kang, Byung Wook Min, Kyu Joo Park, Seung-Bum Ryoo, Heung-Kwon Oh, Min Hyun Kim, Choon Sik Chung, Yong Geul Joh
Annals of Surgical Treatment and Research.2022; 102(4): 234. CrossRef
Laparoscopic Posterolateral Suture Rectopexy for Recurrent Rectal Prolapse in Children
Sherif M. Shehata, Ahmed A. Elhaddad, Wael M. Abo Senna, Mohamed A. Shehat
Journal of Laparoendoscopic & Advanced Surgical Techniques.2019; 29(10): 1292. CrossRef
Changing Trend of Rectal Prolapse Surgery in the Era of the Minimally Invasive Surgery
Suk-Hwan Lee
The Journal of Minimally Invasive Surgery.2019; 22(4): 135. CrossRef

Reviews

Synthetic Versus Biological Mesh-Related Erosion After Laparoscopic Ventral Mesh Rectopexy: A Systematic Review: Andrea Balla, Silvia Quaresima, Sebastian Smolarek, Mostafa Shalaby, Giulia Missori, Pierpaolo Sileri; Ann Coloproctol. 2017;33(2):46-51. Published online April 28, 2017; DOI: https://doi.org/10.3393/ac.2017.33.2.46

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156 Download
47 Web of Science
44 Citations

Abstract PDF

Purpose

This review reports the incidence of mesh-related erosion after ventral mesh rectopexy to determine whether any difference exists in the erosion rate between synthetic and biological mesh.

Methods

A systematic search of the MEDLINE and the Ovid databases was conducted to identify suitable articles published between 2004 and 2015. The search strategy capture terms were laparoscopic ventral mesh rectopexy, laparoscopic anterior rectopexy, robotic ventral rectopexy, and robotic anterior rectopexy.

Results

Eight studies (3,956 patients) were included in this review. Of those patients, 3,517 patients underwent laparoscopic ventral rectopexy (LVR) using synthetic mesh and 439 using biological mesh. Sixty-six erosions were observed with synthetic mesh (26 rectal, 32 vaginal, 8 recto-vaginal fistulae) and one (perineal erosion) with biological mesh. The synthetic and the biological mesh-related erosion rates were 1.87% and 0.22%, respectively. The time between rectopexy and diagnosis of mesh erosion ranged from 1.7 to 124 months. No mesh-related mortalities were reported.

Conclusion

The incidence of mesh-related erosion after LVR is low and is more common after the placement of synthetic mesh. The use of biological mesh for LVR seems to be a safer option; however, large, multicenter, randomized, control trials with long follow-ups are required if a definitive answer is to be obtained.

Citations

Citations to this article as recorded by

Feasibility and safety of biologic OviTex mesh in ventral mesh rectopexy: a prospective pilot study
M. A. Boom, E. M. van der Schans, N. A. T. Wijffels, P. M. Verheijen, E. C. J. Consten
Techniques in Coloproctology.2025;[Epub] CrossRef
Outcomes of laparoscopic ventral mesh rectopexy versus trans-vaginal repair in management of anterior rectocele, a randomized controlled trial
A. Sanad, A. Sakr, H. Elfeki, W. Omar, W. Thabet, E. Fouda, E. Abdallah, S. A. Elbaz
Techniques in Coloproctology.2025;[Epub] CrossRef
Treatment Outcomes of Laparoscopic Suture Rectopexy for Rectal Prolapse
Takamichi Kudo, Taichi Yabuno, Natsuki Hoshino, Shunya Yamamoto, Yasuko Okutsu, Minoru Honma, Yasuhiro Shimizu
Nihon Daicho Komonbyo Gakkai Zasshi.2025; 78(6): 262. CrossRef
Comparative Study on Robotic Ventral Mesh Rectopexy for External Rectal Prolapse When using Biological and Synthetic Meshes
Michael C. Wilkinson, Allison A. Aka, Alexis Plasencia, Jukes P. Namm, Fabrizio Luca
World Journal of Colorectal Surgery.2025; 14(3): 94. CrossRef
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
Langenbeck's Archives of Surgery.2024;[Epub] CrossRef
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Mesh-associated complications in minimally invasive ventral mesh rectopexy: a systematic review
Gabriel Fridolin Hess, Fabio Nocera, Stephanie Taha-Mehlitz, Sebastian Christen, Marco von Strauss Und Torney, Daniel C. Steinemann
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Mustafa Oruc, Timucin Erol
World Journal of Clinical Cases.2023; 11(16): 3680. CrossRef
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Farouk Drissi, Fabien Rogier-Mouzelas, Sebastian Fernandez Arias, Juliette Podevin, Guillaume Meurette
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Jeremy Meyer, Emilie Liot, Vaihere Delaune, Alexandre Balaphas, Bruno Roche, Guillaume Meurette, Frédéric Ris
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Erosion after laparoscopic ventral mesh rectopexy with a biological mesh
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Vaginal Approaches Using Synthetic Mesh to Treat Pelvic Organ Prolapse: Jei Won Moon, Hee Dong Chae; Ann Coloproctol. 2016;32(1):7-11. Published online February 29, 2016; DOI: https://doi.org/10.3393/ac.2016.32.1.7

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7 Web of Science
5 Citations

Abstract PDF

Pelvic organ prolapse (POP) is a very common condition in elderly women. In women with POP, a sacrocolpopexy or a vaginal hysterectomy with anterior and posterior colporrhaphy has long been considered as the gold standard of treatment. However, in recent decades, the tendency to use a vaginal approach with mesh for POP surgery has been increasing. A vaginal approach using mesh has many advantages, such as its being less invasive than an abdominal approach and easier to do than a laparoscopic approach and its having a lower recurrence rate than a traditional approach. However, the advantages of a vaginal approach with mesh for POP surgery must be weighed against the disadvantages. Specific complications that have been reported when using mesh in POP procedures are mesh erosion, dyspareunia, hematomas, urinary incontinence and so on, and evidence supporting the use of transvaginal surgery with mesh is still lacking. Hence, surgeons should understand the details of the surgical pelvic anatomy, the various surgical techniques for POP surgery, including using mesh, and the possible side effects of using mesh.

Citations

Citations to this article as recorded by

Is Vaginal Prosthetic Surgery Always to Be Avoided? Analysis of the Efficacy and Safety of Vaginal Mesh With 3 Levels‐De Lancey Attachment in Women With Recurrent Vaginal Vault Prolapse
Lorenzo Campanella, Giovanni Grossi, Passarello Alessandra, Pietro Cignini, Fabio Manganelli, Pierluigi Palazzetti, M. A. Zullo, Andrea Morciano, Carlo Rappa, Francesco Deltetto, M. C. Schiavi
LUTS: Lower Urinary Tract Symptoms.2025;[Epub] CrossRef
Is HALP score a predictor of poor prognosis in patients with hematologic malignancies admitted to the intensive care unit?
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The Egyptian Journal of Internal Medicine.2024;[Epub] CrossRef
Effects of mesh surgery on sexual function in pelvic prolapse and urinary incontinence
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International braz j urol.2021; 47(1): 82. CrossRef
Functional outcomes of synthetic tape and mesh revision surgeries: a monocentric experience
Salima Ismail, Emmanuel Chartier-Kastler, Christine Reus, Jérémy Cohen, Thomas Seisen, Véronique Phé
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Comparison of advantages and disadvantages of 4- and 6-arm mesh prostheses in reconstructive surgery of the urogenital prolapse in women
О. V. Snurnitsina, M. V. Yenikeev, A. N. Nikitin, L. M. Rapoport, D. V. Enikeev, D. G. Tsarichenko, M. V. Lobanov, A. F. Abdusalamov
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Case Report

Mesh-Based Transperineal Repair of a Perineal Hernia After a Laparoscopic Abdominoperineal Resection: Taek-Gu Lee, Sang-Jeon Lee; Ann Coloproctol. 2014;30(4):197-200. Published online August 26, 2014; DOI: https://doi.org/10.3393/ac.2014.30.4.197

5,722 View
57 Download
11 Web of Science
10 Citations

Abstract PDF

A perineal hernia (PH) is formed by a protrusion of intra-abdominal viscera through a defect in the pelvic floor. This is a rare complication after a conventional abdominoperineal resection (APR). However, the risk of a PH may be increased after a laparoscopic resection because this technique can cause fewer postoperative adhesions, predisposing the small bowel to sliding down toward the pelvis. However, only a few case reports describe the transperineal approach for the repair of a PH after a laparoscopic APR. We present a case of a PH after a laparoscopic APR; the PH was repaired with synthetic mesh by using a transperineal approach. A transperineal approach using a mesh to reconstruct the pelvic floor is less invasive and more effective. We suggest that this technique should probably be the first choice for treating an uncomplicated PH that occurs after a laparoscopic APR.

Citations

Citations to this article as recorded by

Perineal Hernia Repair with synthetic mesh and bivectorial gluteus maximus myocutaneous island flap
Inês Carreira, Nelson Teixeira, Alexandra Rosa, José Guerreiro, Joana Pedro Marques
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The Application of Extraperitoneal Ostomy Combined with Pelvic Peritoneal Reconstruction in Laparoscopic Abdominoperineal Resection for Rectal Cancer
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Composite mesh and gluteal fasciocutaneous rotation flap for perineal hernia repair after abdominoperineal resection: a novel technique
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Perineal hernia repair after abdominoperineal excision or extralevator abdominoperineal excision: a systematic review of the literature
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Short-term Outcomes of an Extralevator Abdominoperineal Resection in the Prone Position Compared With a Conventional Abdominoperineal Resection for Advanced Low Rectal Cancer: The Early Experience at a Single Institution
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Annals of Coloproctology.2016; 32(1): 12. CrossRef

Original Article

Surgical Treatment of a Parastomal Hernia: Seung Chul Heo, Heung-Kwon Oh, Yoon Suk Song, Mi Sun Seo, Eun Kyung Choe, Seungbum Ryoo, Kyu Joo Park; J Korean Soc Coloproctol. 2011;27(4):174-179. Published online August 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.4.174

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Purpose

Parastomal hernia is a major complication of an intestinal stoma. This study was performed to compare the results of various operative methods to treat parastomal hernias.

Methods

Results of surgical treatment for parastomal hernias (postoperative recurrence, complications and postoperative hospital stays) were surveyed in 39 patients over an 11-year period. The patients enrolled in this study underwent surgery by a single surgeon to exclude surgeon bias.

Results

Seventeen patients were male, and twenty-two patients were female. The mean age was 65.9 years (range, 36 to 86 years). The stomas were 35 sigmoid-end-colostomies (90%), 2 loop-colostomies (5%), and 2 double-barrel-colostomies. Over half of the hernias developed within two years after initial formation. Stoma relocation was performed in 8 patients, suture repair in 14 patients and mesh repair in 17 patients. Seven patients had recurrence of the hernia, and ten patients suffered from complications. Postoperative complications and recurrence were more frequent in stoma relocation than in suture repair and mesh repair. Emergency operations were performed in four patients (10.3%) with higher incidence of complications but not with increased risk of recurrence. Excluding emergency operations, complications of relocations were not higher than those of mesh repairs. Postoperative hospital stays were shortest in mesh repair patients.

Conclusion

In this study, mesh repair showed low recurrence and a low complication rate with shorter hospital stay than relocation methods, though these differences were not statistically significant. Further studies, including randomized trials, are necessary if more reliable data on the surgical treatment of parastomal hernias are to be obtained.

Citations

Citations to this article as recorded by

Long-term outcomes after open parastomal hernia repair at a high-volume center
Alexis M. Holland, William R. Lorenz, Brittany S. Mead, Gregory T. Scarola, Vedra A. Augenstein, B. Todd Heniford, Monica E. Polcz
Surgical Endoscopy.2025; 39(1): 639. CrossRef
Parastomal Hernia: direct repair versus relocation: is stoma relocation worth the risk? A comparative meta-analysis and systematic review
Ahmed Abdelsamad, Mohammed Khaled Mohammed, Mohamed Badr Almoshantaf, Aya Alrawi, Ziad A. Fadl, Ziad Tarek, Nada Osama Aboelmajd, Torsten Herzog, Florian Gebauer, Nada K. Abdelsattar, Taha Abd-ElSalam Ashraf Taha
Updates in Surgery.2025;[Epub] CrossRef
Stoma-Related Complications: A Single-Center Experience and Literature Review
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Journal of Interdisciplinary Medicine.2022; 7(2): 31. CrossRef
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Colorectal Disease.2021; 23(2): 476. CrossRef
Prevention and treatment of parastomal hernia: a position statement on behalf of the Association of Coloproctology of Great Britain and Ireland

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Repair of complex parastomal hernias
G. S. Hwang, M. H. Hanna, J. C. Carmichael, S. D. Mills, A. Pigazzi, M. J. Stamos
Techniques in Coloproctology.2015; 19(3): 127. CrossRef
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Techniques in Coloproctology.2014; 18(5): 427. CrossRef
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Der Urologe.2012; 51(7): 965. CrossRef
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Journal of the Korean Society of Coloproctology.2012; 28(6): 299. CrossRef

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