title: How to deal with complications after laparoscopic ventral mesh rectopexy: lessons learnt from a tertiary referral centre.
abstract: OBJECTIVE
  Laparoscopic ventral mesh rectopexy (LVMR) is increasingly recognized as having utility in rectal prolapse, obstructive defaecation syndrome (ODS), faecal incontinence (FI) and multicompartment pelvic floor dysfunction (PFD). This study aimed to highlight gaps in service provision and areas for improvement by examining a cohort of patients with complications referred to a tertiary centre.
  
  
  METHODS
  Examination was carried out of a password-protected electronic database of all LVMRs operated on in one institution.
  
  
  RESULTS
  Fifty patients (45 women), median age 54 (range, 24-71) years, were referred with early symptomatic failure (n = 27) following an inadequate LVMR or major mesh complications (erosion into another organ, fistulation or stricturing) (n = 23). All were amenable to remedial laparoscopic surgery. Functional improvements were found in pre- and postoperative ODS, Wexner (FI) scores (two-tailed t-test; P < 0.0001) and quality of life (Birmingham Bowel and Urinary Symptoms Questionnaire-22) scores at 3 months (two-tailed t-test; P < 0.001) and normalization at 1 year (P < 0.015). This was mirrored by improved linear bowel symptom severity visual analogue scale scores (two-tailed t-test; P < 0.0001 at 3 months and P = 0.015 at 1 year) .
  
  
  CONCLUSIONS
  LVMR can be associated with technical complications arising from inadequate technique or from operation-specific complications that are amenable to complex revisional laparoscopic surgery with significant improvement in quality of life and function.
authors: Colorectal & Pelvic Floor Surgery, Frenchay & SPIRE Hospitals Bristol, Bristol, UK.
authors: A H
authors: AH
authors: Badrek-Al Amoudi
authors: G L
authors: GL
authors: Greenslade
authors: A R
authors: AR
authors: Dixon
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003248:Constipation / Q000209:etiology / Q000601:surgery*; D020878:Device Removal; D013505:Digestive System Surgical Procedures; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D059952:Pelvic Floor Disorders / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D011475:Prosthesis Failure; D012005:Rectal Prolapse / Q000150:complications / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013526:Surgical Mesh; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult