title: Laparoscopic Rectopexy with Urinary Bladder Xenograft Reinforcement.
abstract: OBJECTIVE
  Rectal prolapse is often repaired laparoscopically, frequently with the use of reinforcement material. Both synthetic and biologically derived materials reduce recurrence rate compared to primary suture repair. Synthetic mesh introduces potential complications such as mesh erosion, fibrosis, and infection. Urinary bladder matrix (UBM) represents a biologically derived material for reinforcement of rectal prolapse repair with the potential to improve durability without risks of synthetic materials. The objective of the study is to evaluate the effectiveness, durability, and functional result of laparoscopic rectopexy using urinary bladder matrix xenograft reinforcement at three years follow up.
  
  
  METHODS
  The 20 cases presented describe rectal prolapse repair by means of laparoscopic rectopexy with presacral UBM reinforcement. Patients were followed up for an average of 3 years and assessed with interviews, physical examination, manometry, and the fecal incontinence severity index (FISI).
  
  
  RESULTS
  Each repair was completed laparoscopically. UBM exhibited favorable handling characteristics when sutured to the sacrum and the lateral rectal walls. One patient underwent laparoscopic drainage of a postoperative abscess; no other complications occurred. In 3 years of follow-up, there have been no full-thickness recurrences, erosions, reoperations, or long-term complications. Two patients exhibited a small degree of mucosal prolapse on follow-up physical examination that did not require surgery. Three-year FISI scores averaged 8 (range, 0-33 of a possible 61), indicating low fecal incontinence symptomatology. Follow-up anorectal manometry was performed in 9 patients, showing mixed results.
  
  
  CONCLUSIONS
  Surgeons may safely use laparoscopic rectopexy with UBM reinforcement for repair of rectal prolapses. In this series, repairs with UBM grafts have been durable at 3-year follow-up and may be an alternative to synthetic mesh reinforcement of rectal prolapse repairs. Future studies may compare the advantages and cost-effectiveness of reinforcement materials for rectal prolapse repair.
authors.affiliation: University of Nevada School of Medicine, Reno, Nevada, USA.
authors.forename: Aradhana
authors.initials: A
authors.lastname: Mehta
authors.affiliation: University of Nevada School of Medicine, Reno, Nevada, USA.
authors.forename: Rami
authors.initials: R
authors.lastname: Afshar
authors.affiliation: University of Nevada School of Medicine, Reno, Nevada, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Warner
authors.affiliation: University of Nevada School of Medicine, Reno, Nevada, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Gardner
authors.affiliation: University of Nevada School of Medicine, Reno, Nevada, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Ackerman
authors.affiliation: University of Nevada School of Medicine, Reno, Nevada, USA.
authors.forename: Jared
authors.initials: J
authors.lastname: Brandt
authors.affiliation: University of Nevada School of Medicine, Reno, Nevada, USA.
authors.forename: Kent C
authors.initials: KC
authors.lastname: Sasse
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D005260:Female; D005500:Follow-Up Studies; D064593:Heterografts / Q000637:transplantation*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012005:Rectal Prolapse / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012008:Recurrence; D014183:Transplantation, Heterologous / Q000379:methods*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000637:transplantation*
keywords: Laparoscopic rectopexy; Rectal prolapse; Urinary bladder matrix