Comparative Study on Robotic Ventral Mesh Rectopexy for External Rectal Prolapse When using Biological and Synthetic Meshes

Background: The use of biological versus synthetic meshes in robotic ventral mesh rectopexy (RVMR) remains debated. Objectives: Surgical outcomes, recurrences, and postoperative complications resulting from RVMR using biological versus synthetic meshes were assessed. Design: A single-center, retrospective cohort study. Setting: A high-volume tertiary referral center in the period 2016–2021. Patient and Methods: All adult female patients with external rectal prolapse treated with RVMR by using biological or synthetic meshes were compared with logistic regression. Main Outcome Measure: The recurrence rate and risk factors independently associated with recurrence. Sample Size: Forty-two female patients received either biological or synthetic meshes. Results: The mean age (68.6 vs. 68.9 years; P = .96) and body mass index (BMI) (26.4 vs. 26.7 kg/m 2 ; P = .90) were similar between the two groups. The patients with concomitant gynecologic surgery received synthetic mesh more frequently (26.7 vs. 58.3%; P = .05). Recurrence rates did not differ between the two groups (20.0 vs. 16.7%; P = .80). In the mean follow-up durations of 18.7 ± 18.8 and 13.4 ± 19.6 months, P = .21, there were no mesh-related complications in both groups. There was no statistically significant increase in the odds of recurrence with biological mesh selection (odds ratio (OR) 1.2; (95% confidence interval (CI) = 0.21–7.3); P = .80), associated gynecologic procedure (OR 1.1; (95% CI = 0.22–5.4); P = .91), older age (OR 1.01; (95% CI = 0.96–1.06); P = .78), or higher BMI (OR 1.05; (95% CI = 0.93–1.19); P = .42). Conclusion: Complete rectal prolapse in women is effectively treated with RVMR, with similar recurrence rates on follow-up based on mesh type. Caution is advised when comparing mesh-related recurrence rates in multicompartmental or incomplete prolapse. Limitations: Retrospective study; an underpowered sample, which could have introduced a type 2 statistical error; surgeon preference for mesh type; and short follow-up duration. Conflict of Interest: None.