title: Intrarectal migration of mesh following Rectopexy: Case series and review of literature.
abstract: BACKGROUND
  Mesh rectopexy for complete rectal prolapse is associated with complications such as fecal impaction, constipation and rarely recurrence. Mesh erosion following rectopexy is rare. We report three such cases managed successfully in our unit.
  
  
  METHODS
  All three patients presented with constipation. In addition, one patient had sense of incomplete evacuation and another had protrusion of mesh through anal canal with recurrence of rectal prolapse. There was a delayed presentation in one patient at 15 years after initial surgery, while other two presented at 2 years and 5 years following rectopexy. Diagnosis was made by either per rectal examination or sigmoidoscopy. Two patients underwent trans abdominal removal of mesh along with anterior resection of rectum. In one patient, mesh was removed by transanal approach and sutured rectopexy was added to tackle the recurrent prolapse. All patients are symptom free on follow up with no recurrence of prolapse.
  
  
  CONCLUSIONS
  Mesh erosion following rectopexy has multifactorial aetiology with diverse presentation. It is important to recognise this significantly morbid complication as it amenable to surgical correction. Management depends up on the location of erosion, the severity of mesh protrusion into rectal lumen and the degree of fibrosis around the area of mesh.
  
  
  CONCLUSIONS
  The management of mesh erosion following rectopexy should be individualized. Although it is complex, acceptable functional outcome and quality of life can be achieved with proper treatment.
authors.affiliation: Department of Gastrointestinal Surgery, G B Pant Institute of Post Graduate Medical Education and Research and Maulana Azad Medical College, New Delhi, India.
authors.forename: Nilesh Sadashiv
authors.initials: NS
authors.lastname: Patil
authors.affiliation: Department of Gastrointestinal Surgery, G B Pant Institute of Post Graduate Medical Education and Research and Maulana Azad Medical College, New Delhi, India.
authors.forename: Sundeep Singh
authors.initials: SS
authors.lastname: Saluja
authors.affiliation: Department of Gastrointestinal Surgery, G B Pant Institute of Post Graduate Medical Education and Research and Maulana Azad Medical College, New Delhi, India. Electronic address: surgeonmishra@yahoo.com.
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Mishra
authors.affiliation: Department of Gastrointestinal Surgery, G B Pant Institute of Post Graduate Medical Education and Research and Maulana Azad Medical College, New Delhi, India.
authors.forename: Nisha
authors.initials: N
authors.lastname: Solanki
authors.affiliation: Department of Gastrointestinal Surgery, G B Pant Institute of Post Graduate Medical Education and Research and Maulana Azad Medical College, New Delhi, India.
authors.forename: Kunal
authors.initials: K
authors.lastname: Parasar
mesh_terms: D005260:Female; D005548:Foreign-Body Migration / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012005:Rectal Prolapse / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012008:Recurrence; D013526:Surgical Mesh
keywords: Mesh erosion; Mesh rectopexy; Rectal prolapse