Our Summary

The use of mesh prosthetics in pelvic surgery, particularly in procedures done through the vagina, has raised concerns due to potential safety issues. In 2017, health authorities in Australia and New Zealand announced regulatory actions relating to these mesh products. One type of pelvic surgery where mesh is commonly used is for the treatment of rectal prolapse, a condition where part of the rectum slips outside the anus. A specific procedure called ventral mesh rectopexy (VMR) has gained popularity recently. The research so far indicates that VMR is a safe procedure and has some advantages over other methods of treating rectal prolapse. However, most of the data available is based on short-term outcomes. More research, especially long-term studies, is needed to fully understand the safety of using mesh in these surgeries. In the meantime, steps can be taken to improve surgical practices, such as better reporting, training, and patient education. This paper aims to summarize the current state of pelvic floor mesh surgery and its potential impacts on colorectal pelvic floor surgery.

FAQs

  1. What is the current controversy surrounding the use of mesh prostheses in pelvic surgery?
  2. How is pelvic mesh used in colorectal surgery and what are its advantages?
  3. What are the current gaps in understanding the long-term safety of mesh in colorectal surgery?

Doctor’s Tip

One helpful tip a doctor might give a patient about colorectal surgery is to make sure to follow the post-operative care instructions carefully, including proper wound care, medication management, and activity restrictions. It is important to attend follow-up appointments and communicate any concerns or changes in symptoms to your healthcare provider. It is also important to maintain a healthy diet and lifestyle to support proper healing and recovery.

Suitable For

Patients who are typically recommended for colorectal surgery include those with colorectal cancer, inflammatory bowel disease, diverticulitis, and rectal prolapse. In the case of rectal prolapse, pelvic mesh may be used in procedures such as ventral mesh rectopexy (VMR) to provide additional support to the rectum. Despite the controversy surrounding the use of pelvic mesh in other pelvic surgeries, current evidence suggests that VMR is a safe and effective procedure for rectal prolapse. However, further studies are needed to assess the long-term safety and efficacy of pelvic mesh in colorectal surgery. In the meantime, optimizing surgical practices, reporting, training, and patient education are important considerations for surgeons performing these procedures.

Timeline

Before colorectal surgery:

  1. Patient is diagnosed with a condition such as rectal prolapse or colorectal cancer.
  2. Patient undergoes preoperative testing and consultations with healthcare providers.
  3. Patient may undergo bowel preparation to clean out the colon before surgery.
  4. Patient receives instructions on what to expect before and after surgery.

After colorectal surgery:

  1. Patient undergoes the surgical procedure, which may involve the use of pelvic mesh in the case of rectal prolapse.
  2. Patient is monitored closely in the postoperative period for complications such as infection or bleeding.
  3. Patient may experience pain, swelling, and discomfort in the surgical area.
  4. Patient gradually resumes eating and drinking, and may be discharged from the hospital once they are able to tolerate food and have normal bowel function.
  5. Patient may require a period of rest and recovery at home, with restrictions on activities such as heavy lifting.
  6. Patient follows up with healthcare providers for monitoring of healing and any potential complications.
  7. Patient may undergo physical therapy or other interventions to aid in recovery and improve function.
  8. Patient gradually resumes normal activities and may undergo additional follow-up testing to monitor long-term outcomes.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with colorectal surgery using mesh prostheses?
  2. What are the alternative treatment options for my condition, and how do they compare to using mesh prostheses?
  3. What is the success rate of colorectal surgery using mesh prostheses, and what can I expect in terms of recovery and long-term outcomes?
  4. How experienced are you in performing colorectal surgery with mesh prostheses, and what is your success rate?
  5. Are there any specific pre-operative preparations or post-operative care instructions I should be aware of?
  6. How will the presence of mesh prostheses affect any future medical procedures or imaging tests I may need?
  7. What is the current regulatory status of mesh prostheses in pelvic surgery, and how does this impact my decision to undergo colorectal surgery with mesh?
  8. Are there any ongoing studies or research regarding the safety and efficacy of using mesh prostheses in colorectal surgery?
  9. Can you provide me with information or resources to help me make an informed decision about undergoing colorectal surgery with mesh prostheses?
  10. What is your policy on reporting and monitoring any complications or adverse events related to colorectal surgery using mesh prostheses?

Reference

Authors: Collinson RJ, Moot AR. Journal: N Z Med J. 2019 Oct 4;132(1503):93-99. PMID: 31581186