Mehta Aradhana, Afshar Rami, Warner David L, Gardner Amy, Ackerman Ellen, Brandt Jared, Sasse Kent C
University of Nevada School of Medicine, Reno, Nevada, USA.
JSLS. 2017 Jan-Mar;21(1). doi: 10.4293/JSLS.2016.00106.
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.
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).
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.
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.
直肠脱垂常通过腹腔镜进行修复，通常会使用加固材料。与单纯缝合修复相比，合成材料和生物衍生材料均可降低复发率。合成网片会引发诸如网片侵蚀、纤维化和感染等潜在并发症。膀胱基质（UBM）是一种用于直肠脱垂修复加固的生物衍生材料，有望提高修复的耐久性且无合成材料的风险。本研究的目的是在三年随访期评估使用膀胱基质异种移植物加固的腹腔镜直肠固定术的有效性、耐久性和功能结果。
所呈现的20例病例描述了通过腹腔镜直肠固定术加骶前UBM加固来修复直肠脱垂。患者平均随访3年，并通过访谈、体格检查、测压和大便失禁严重程度指数（FISI）进行评估。
每次修复均通过腹腔镜完成。将UBM缝合至骶骨和直肠侧壁时，其操作特性良好。1例患者接受了术后脓肿的腹腔镜引流；未发生其他并发症。在3年的随访中，未出现全层复发、侵蚀、再次手术或长期并发症。2例患者在随访体格检查时出现轻度黏膜脱垂，无需手术。三年FISI评分平均为8分（范围为0至可能的61分中的33分），表明大便失禁症状较轻。9例患者进行了随访肛门直肠测压，结果不一。
外科医生可安全地使用UBM加固的腹腔镜直肠固定术来修复直肠脱垂。在本系列研究中，使用UBM移植物的修复在3年随访期内效果持久，可能是直肠脱垂修复中合成网片加固的一种替代方法。未来的研究可比较直肠脱垂修复加固材料的优势和成本效益。
