Synthetic versus biological mesh-related erosion after laparoscopic ventral mesh rectopexy. A systematic review

Purpose: This review reports the incidence of mesh-related erosion after ventral mesh rectopexy to determine whether any difference exists in the erosion rate between synthetic and biological mesh. Methods: A systematic search of the MEDLINE and the Ovid databases was conducted to identify suitable articles published between 2004 and 2015. The search strategy capture terms were laparoscopic ventral mesh rectopexy, laparoscopic anterior rectopexy, robotic ventral rectopexy, and robotic anterior rectopexy. Results: Eight studies (3,956 patients) were included in this review. Of those patients, 3,517 patients underwent laparoscopic ventral rectopexy (LVR) using synthetic mesh and 439 using biological mesh. Sixty-six erosions were observed with synthetic mesh (26 rectal, 32 vaginal, 8 recto-vaginal fistulae) and one (perineal erosion) with biological mesh. The synthetic and the biological mesh-related erosion rates were 1.87% and 0.22%, respectively. The time between rectopexy and diagnosis of mesh erosion ranged from 1.7 to 124 months. No mesh-related mortalities were reported. Conclusion: The incidence of mesh-related erosion after LVR is low and is more common after the placement of synthetic mesh. The use of biological mesh for LVR seems to be a safer option; however, large, multicenter, randomized, control trials with long follow-ups are required if a definitive answer is to be obtained

Case Report: Metastatic breast cancer to the gallbladder

Cholecystitis is one of the leading causes of emergency surgical interventions; the occurrence of metastases to the gallbladder is rare and has only been reported in the literature exceptionally. Metastatic breast cancer to the gallbladder is even less frequent; in fact, breast cancer usually metastasizes to bone, lung, lymph nodes, liver and brain. We report the case of an 83-year-old female patient with a previous history of breast surgery with axillary dissection in 1997, followed by adjuvant chemotherapy due to invasive ductal carcinoma of the left breast. The patient was admitted at the emergency department for sepsis and an episode of acute kidney failure, anuria and fever. Right-upper quadrant abdominal pain triggered by food intake and abdominal tenderness was also present, placing the diagnostic suspicion of biliary sepsis due to acute cholecystitis. The histological examination of the surgical specimen highlighted the presence of metastasis from an infiltrating ductal breast carcinoma with positive hormone receptors. We also report here the results of a review of the literature looking at articles describing cases of gallbladder metastasis from breast cancer

Vaginal Evisceration of Small Bowel With Extraperitoneal Ileal Resection of the Herniated Loops: A Case Report

Introduction: Vaginal evisceration is an extremely rare surgical emergency that can be described as the extrusion of abdominal viscera through a defect or a rupture of the vaginal wall. We reported the case of an acute abdomen due to small bowel evisceration secondary to vaginal vault dehiscence that required combined vaginal-abdominal approach Case: We discuss the case of a 72-year-old female who presented to the emergency department for a large prolapse with visible extrusion of the small bowel per vagina. The eviscerated bowel was resected by external vaginal approach due to excessive swelling of the loops which made it impossible to reduce them through the vagina defect. A midline laparotomy was undertaken for further assessment, and the vault defect was closed by transabdominal repair Conclusion: From its first description in 1864, just a few cases of vaginal evisceration had been described in the medical literature; the most common organ to eviscerate is the distal ileum, although cases of omentum, colon, fallopian tube, and appendix evisceration have also been reported. We described a rare case of transvaginal evisceration of the small bowel in our emergency department; it is a rare surgical emergency that must be managed to prevent serious consequences, such as bowel ischemia and necrosis, sepsis, and death. We suggest that a multidisciplinary approach to prompt examination and management by gynecologists and general surgeons is recommended to reduce the risk of morbidity and mortality. With this paper the authors would like to share the surgical manage of this rare emergency with other surgeons all around the world

Correction to: Interstitial cells of Cajal increased in patients with rectal prolapse

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Minimally-invasive multidisciplinary treatment of deep endometriosis: 103 cases

Background: Endometriosis is a multifactorial disease which can cause severe pelvic pain that can impact everyday life. In addition, the complex of pain, inflammation, altered pelvic anatomy, adhesions, disrupted ovarian reserve/function, and compromised endometrial receptivity is a common cause of infertility. The treatment of this disease should be individualized according to the clinical situation and to the level of impairment. This study aims to define the role of surgery in the treatment of deep endometriosis with intestinal localization, particularly whether surgery is capable or not to improve painful symptoms, disease recurrence, and fertility. Methods: In this retrospective clinical single-arm study, from March 2017 to March 2022, we included all patients who underwent to surgical intervention involving bowel resection for deep endometriosis. To analyze the effects of surgery in improving symptoms a standardized questionnaire, based on the verbal rating scale (VRS) [0–4], was given pre-operatively on the first gynecological visit and post-operatively at least 6 months from intervention. In addition, each patient seeking a pregnancy before surgery was contacted at the end of the follow-up to find out whether she had a full-term pregnancy or not. Results: A total of 103 patients undergoing surgery for deep endometriosis involving the intestinal tract were included in the present study. The indication for surgery was given based on the severity of the symptoms, the desire for pregnancy, or a combination of the two. The 28.9% of the patients became completely asymptomatic after intervention and reported a clear decrease in the intensity of the painful symptomatology. The average pre-operative VRS score was 1.37, in the post-operative period, the average VRS score was 0.4, a difference that was statistically significant. About fertility, we observed a 20% increase after surgery. Conclusions: Deep endometriosis is an aggressive form of endometriosis which has a great impact in patients’ quality of life. Medical therapy control symptoms without a real resolution of them. This study emphasizes as surgical minimally invasive treatment represents the gold standard for the cure of deep endometriosis with excellent results on infertility and symptoms improvement

Corrigendum. Synthetic versus biological mesh-related erosion after laparoscopic ventral mesh rectopexy. A systematic review

To the editor: It was my pleasure that I have published paper in your prestigious journal Annals of Coloproctology with title "Synthetic Versus Biological Mesh-Related Erosion After Laparoscopic Ventral Mesh Rectopexy: A Systematic Review." Unfortunately, I noticed that by mistake I forget to add both of my affiliation "Department of General Surgery, Mansoura University" beside "Department of General Surgery, Tor Vergata University." I understand that this is the authors' responsibility to check their affiliation, but I will appreciate of you make a corrigendum for this. Thank you in advance. Mostafa Shalaby The fourth author's affiliation should be corrected as follows. Corrected affiliation Andrea Balla, Silvia Quaresima1, Sebastian Smolarek2, Mostafa Shalaby1,3, Giulia Missori1, Pierpaolo Sileri1 Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Rome, Italy; 1Department of Surgery, Tor Vergata University, Rome, Italy; 2Pelvic Oncology Fellow, Abertawe Bro Morgannwg University Health Board, Swansea, UK; 3Department of General Surgery, Mansoura University, Mansoura, Egypt