title: Comparative study of safety and efficacy of synthetic surgical glue for mesh fixation in ventral rectopexy.
abstract: Ventral mesh rectopexy (VMR) is a surgical option to treat rectal prolapse with pelvic floor dysfunction (PFD). Using synthetic surgical glue to fix the mesh to the anterior rectal wall after ventral dissection could be advantageous in comparison with sutured or stapled fixation. This study aimed to evaluate the safety and efficacy of synthetic surgical glue for mesh fixation compared with suture mesh fixation in VMR.
  
  
  
  This observational cohort study is a retrospective analysis conducted in a University Hospital Pelvic Surgery Center. All consecutive female patients (n = 176) who underwent laparoscopic or laparotomic VMR between January 2009 and December 2014 were included. Two groups were defined based on mesh fixation technique of the rectal wall: VMR with synthetic glue (n = 66) and VMR with suture (n = 110). The recurrence-free survival after VMR was determined by Kaplan-Meier method and multivariate analysis by Cox regression. Short-term postoperative complications, postoperative symptom improvement, the need for complementary treatment postoperatively, and procedure length were evaluated.
  
  
  
  A total of 176 females patients (mean age, 58.6 ± 13.7 years) underwent VMR with synthetic mesh. Mean recurrence-free survivals after VMR were 17.16 (CI 95% 16.54-17.80) and 17.33 (CI 95% 16.89-17.77) months in the glue group and the suture group, respectively (p > 0.05). Cox regression identified an independent effect on the recurrence risk of the external rectal prolapse, alone, or in combination with other anatomical abnormalities (HR = 0.37; CI 95% 0.14-0.93; p = 0.03). There was no significant difference of short-term postoperative morbidity, procedure length, postoperative symptom improvement, or need for complementary treatment postoperatively between suture versus glue groups (all p > 0.05).
  
  
  
  Use of glue to fix the mesh in VMR was safe and had no impact on outcomes. External prolapse was the unique significant predictive factor for recurrence.
authors.affiliation: Service de Chirurgie Digestive, CHU de Toulouse, CHU Purpan, Place du Dr. Baylac, 31059, Toulouse, France.|Serviço de Cirurgia Geral, Universidade Federal de Pernambuco, Recife, Brazil.
authors.forename: Raquel Kelner
authors.initials: RK
authors.lastname: Silveira
authors.affiliation: Service de Chirurgie Digestive, CHU de Toulouse, CHU Purpan, Place du Dr. Baylac, 31059, Toulouse, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Domingie
authors.affiliation: Service de Chirurgie Digestive, CHU de Toulouse, CHU Purpan, Place du Dr. Baylac, 31059, Toulouse, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Kirzin
authors.affiliation: Núcleo de Saúde Pública, Universidade Federal de Pernambuco, Recife, Brazil.
authors.forename: Djalma Agripino
authors.initials: DA
authors.lastname: de Melo Filho
authors.affiliation: Service de Chirurgie Digestive, CHU de Toulouse, CHU Purpan, Place du Dr. Baylac, 31059, Toulouse, France. portier.g@chu-toulouse.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Portier
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D059952:Pelvic Floor Disorders / Q000150:complications / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D012005:Rectal Prolapse / Q000150:complications / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects*; D015996:Survival Rate; D013537:Sutures / Q000009:adverse effects; D014014:Tissue Adhesives / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D014014:Tissue Adhesives
keywords: Cyanoacrylate glue; Pelvic floor dysfunction; Rectal prolapse; Surgical glue; Surgical mesh; Ventral mesh rectopexy