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Session: ePoster Monitor 4-Pelvic Floor 1

eP486 - Ventral Mesh Rectopexy for Recurrent Rectal Prolapse After Altemeier Perineal Proctosigmoidectomy: Safety, Feasibility, and Outcomes

Sunday, June 2, 2024
4:06 PM – 4:11 PM ET, USA
Location: Baltimore Convention Center, Room 318-320

    ePoster Presenter(s)

  • Lukas Schabl, MD

    Researcher
    Cleveland Clinic, Cleveland Ohio
    Cleveland Clinic, Ohio, USA
    Cleveland, OH, United States

    All relevant financial disclosures have been managed and will be listed below.
    This individual has no relevant relationships with ineligible companies.

    • Author(s)

  • Tracy L. Hull, MD

    Staff Surgeon
    Department of Colorectal Surgery, Cleveland Clinic
    Cleveland Clinic Foundation, Lerner School of Medicine of Case Western University
    Chagrin Falls, Ohio, United States

    All relevant financial disclosures have been managed and will be listed below.
    This individual has no financial relationships with ineligible companies.

  • Kamil Erozkan, MD, FACS (he/him/his)

    Clinical Research Fellow
    Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic
    Cleveland Clinic
    Cleveland, OH, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • Ali Alipouriani, MD

    Clinical Research Fellow
    Department of colorectal surgery, Cleveland Clinic Foundation
    Department of colorectal surgery, Cleveland Clinic Foundation
    Cleveland, OH, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • Kristen A. Ban, MD

    Colorectal Surgeon
    Cleveland Clinic Foundation
    C;leveland, Ohio, United States

    Disclosure information not submitted.

  • RG

    Rebecca Gunter, MD

    Staff Surgeon
    Hillcrest Hospital, Departement Colorectal Surgery, Cleveland Clinic, Cleveland Ohio
    Cleveland, Ohio, United States

    Disclosure information not submitted.

  • Scott Steele, MD MBA

    President, Chairman, Staff Surgeon
    Department of Colorectal Surgery, Cleveland Clinic
    Cleveland, Ohio, United States

    All relevant financial disclosures have been managed and will be listed below.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • Anna R. Spivak, DO (she/her/hers)

    Staff Surgeon
    Department of Colorectal Surgery, Cleveland Clinic
    Cleveland Clinic Foundation
    Cleveland, Ohio, United States

    All relevant financial disclosures have been managed and will be listed below.
    This individual has no financial relationships with ineligible companies.

Purpose/Background: Recurrence of rectal prolapse following Altemeier procedure is reported with rates up to 40%. Limited data are available on the optimal surgical management of recurrent rectal prolapse. Ventral mesh rectopexy (VMR) is a favored procedure for primary rectal prolapse but its role of managing recurrence after Altemeier remains unclear. In contrast to VMR in primary rectal prolapse where the mesh is implanted on the rectum, the mesh in VMR for recurrent prolapse after previous Altemeier is implanted on the colon. The colon has a thinner wall, more active peristalsis, no mesorectum, and less peritoneum available to cover the mesh. These factors could potentially affect mesh related complications such as mesh erosion, migration, or infection. This study seeks to assess the safety and feasibility of mesh placement on the colon. Additionally, we evaluate recurrence rates and outcomes after utilizing ventral mesh rectopexy as a treatment option for recurrent rectal prolapse after Altemeier procedure.Methods/Interventions: We analyzed data from our prospectively maintained prolapse database for patients who had experienced full-thickness rectal prolapse recurrence following perineal proctosigmoidectomy and subsequently underwent ventral mesh rectopexy. We examined patient data for complications and recurrence.Results/Outcomes: 8 women with a median age of 65 years (34-89) and a median BMI of 30 kg/m2 (24-33) were included. 4 (50%) had only one Altemeier procedure before VMR, and 4 (50%) had multiple rectal prolapse surgeries including Altemeier before VMR. During a median follow-up period of 79 months (27-167), no mesh related complications occurred. Three (37.5%) patients experienced minor postoperative complications unrelated to the mesh implant. Long-term complications, likewise, unrelated to the mesh, occurred in two patients (20%). Patients with only one previous prolapse repair had no (0%) recurrence, while all patients (100%) with multiple prior repairs recurred.Conclusion/

Discussion: The implantation of mesh on the colon level is safe and feasible without associated adverse, mesh-related complications. VMR resulted in no recurrences in patients with primary rectal prolapse recurrence after Altemeier. The recurrence rate in patients with multiple previous rectal prolapse surgeries was high, raising doubt of VMR usage in patients with secondary or tertiary recurrences. These findings provide valuable insights into the application of ventral mesh rectopexy on the colon and the management of recurrent rectal prolapse.