Mesh not necessary for laparoscopic rectopexy

​Lately there have been several concerns about safety of synthetic mesh for surgery in the pelvis. Migration of the mesh, erosion into adjacent bowel, formation of dense adhesions and chronic pain have been described in several studies and there also have been some high profile legal cases. The alternative use of biological mesh has been tried, however the main problem with that is the extremely high cost of that mesh. Biological mesh also has less strength and shrinks more than synthetic mesh and its long term efficacy has not been reported yet. 

​Laparoscopic rectopexy with the use of sutures has been reported and is also practiced by the author. It is a simple and efficient way to fixate the rectum onto the pre sacral fascia. The only caveat: it requires skills in laparoscopic suturing! Yasukawa et al have described a series of 15 patients who had successful laparoscopic suture rectopexy for rectal prolapse without complications and very low recurrence (read the results here). The technique is promising and should be formally studied.