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A systematic review of the management of synthetic mesh erosion of the rectum following urogynaecological surgery
Author(s) -
Younan HC.,
Machin M.,
Myers A. F.,
Slesser A. A. P.,
Mohsen Y.
Publication year - 2020
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.14758
Subject(s) - medicine , surgery , rectum , medline , cochrane library , colorectal surgery , abdominal surgery , clinical trial , prospective cohort study , cohort study , general surgery , randomized controlled trial , political science , law
Aim Synthetic rectal mesh erosion is a challenging complication following urogynaecological surgery. The aim of this study was to determine the optimal management of rectal mesh erosion following urogynaecological surgery. Method A systematic review was undertaken following a pre‐defined protocol registered with PROSPERO ( CRD 42018112425) in accordance with PRISMA guidelines. Searches of MEDLINE online database, Cochrane Library and clinical trial registries (ClinicalTrials.gov, EU Clinical Trials, ISRCTN registry) were performed. The included articles were heterogeneous – therefore a narrative synthesis was performed. Results Fourteen studies were included in the review: 11 case reports, one case series, one retrospective cohort and one prospective multicentre trial. Fourteen rectal mesh erosions were identified. Eight (57%) of the rectal erosions underwent major abdominal surgery. In two of these cases, the abdominal approach was used only after failure of the transanal route. Five (36%) of the mesh erosions were managed using a transanal approach. In one case, the mesh passed without intervention. Conclusion Synthetic rectal mesh erosion can be managed successfully via either a transanal or a transabdominal approach with a partial or complete excision of the mesh. An examination under anaesthetic with an attempted transanal removal of mesh should be considered the first step in the management of this condition before consideration of more invasive surgery.