Mesh voor behandeling rectumprolaps door LVR
Uitgangsvraag
Welk materiaal (type mesh) dient gebruikt te worden bij een laparoscopische ventrale rectopexie?
Aanbeveling
Plaats bij voorkeur een synthetisch implantaat bij een laparoscopische ventrale rectopexie voor een behandeling van een rectumprolaps. Gezien de afwezigheid van lange termijns resultaten voor biologische implantaten geldt het gebruik van een synthetisch implantaat als standaard zorg.
Indien gebruik van een biologisch implantaat wordt gekozen, bespreek dan tijdens shared decision making expliciet met de patiënt dat lange termijns resultaten van het gebruik van biologische mesh ontbreken.
Overwegingen
Balans tussen gewenste en ongewenste effecten
Er is een literatuuronderzoek verricht om te achterhalen welk materiaal (type mesh) gebruikt dient te worden bij een laparoscopische ventrale rectopexie.
Er zijn vijf studies geïncludeerd die biologische mesh vergeleken met synthetische mesh. De cruciale uitkomstmaten waren terugkerende prolaps en complicaties (o.a. infecties en erosie van de mesh). De overall bewijskracht hiervoor is zeer laag. Ook voor de belangrijke uitkomstmaten is de bewijskracht zeer laag.
Het gebruik van een biologische mesh bij een laparoscopische ventrale rectopexie voor een behandeling van een rectumprolaps laat op de korte termijn (max mean follow-up van 22.3 maanden (Fu, 2017)) geen verschil zien vergeleken met een synthetische mesh t.a.v. de uitkomsten recidief en/ of complicaties. Ook met betrekking tot functional outcomes zijn er geen verschillen tussen het gebruik van biologische en synthetische mesh.
Kwaliteit van bewijs
De overall kwaliteit van bewijs is zeer laag. Dit betekent dat we zeer onzeker zijn over het geschatte effect van de onderzochte uitkomstmaten.
Er is afgewaardeerd vanwege ernstige:
- Risk of Bias: methodologische beperkingen in de geïncludeerde observationele studies, waaronder gebrek aan randomisatie, beperkte correctie voor confounders en gebruik van niet-gevalideerde uitkomstmaten.
- Imprecisie: kleine aantallen patiënten en uitkomsten, en brede betrouwbaarheidsintervallen of het ontbreken van effectschattingen.
Waarden en voorkeuren van patiënten (en eventueel hun naasten/verzorgers)
Uit lange termijn studies blijkt het risico (met name op erosie en infectie) van het gebruik van een synthetische mesh bij ventrale mesh rectopexie zeer laag. Ten gevolge van negatieve publiciteit van synthetische meshes (wat bijvoorbeeld in het Verenigd Koninkrijk heeft geleid tot een verbod van het gebruik) bestaat bij een (kleine) groep patiënten een grote zorg rondom het plaatsen van dit materiaal in hun lichaam. De potentiële gevolgen van een dergelijke (zeldzame) infectieuze complicatie van een synthetische mesh zijn wel degelijk significant en moeten besproken worden met de patiënt die een implantaat krijgt.
Gezien de zeer lage kans op complicaties en de bekende gunstige lange termijn resultaten is het gebruik van een synthetische mesh de gouden standaard. Het gebruik van een biologische mesh kan besproken worden in specifieke gevallen, waarbij de afwezigheid van resultaten op de lange termijn besproken dient te worden. Hierin dient ook de overweging meegenomen te worden, dat recidieve-chirurgie een duidelijk slechter risicoprofiel kent dan de primaire operatie (Laitakari, 2021 & van der Schans, 2021). Gezien de afwezigheid van lange termijn resultaten bestaat de kans dat het gebruik van een biologisch implantaat zal leiden tot meer recidieve-chirurgie.
In de praktijk is gebleken dat verschillende typen/merken synthetische meshes worden toegepast bij laparoscopische ventrale mesh rectopexie. Het is belangrijk na te gaan of de mesh inderdaad geregistreerd is voor dit gebruik, of dat de toegepaste mesh off-label gebruikt wordt. In het laatste geval dient de chirurg de patiënt hiervan op de hoogte te brengen en dit als zodanig te documenteren. In de “bijsluiter” van de mesh kan worden nagegaan of deze voor de toepassing rectopexie geregistreerd staat.
Kostenaspecten
Er zijn momenteel geen onderzoeken bekend waarin kosten als uitkomstmaat zijn meegenomen bij de vergelijking tussen biologische en synthetische meshes in het kader van laparoscopische ventrale rectopexie voor de behandeling van rectumprolaps. Over het algemeen geldt dat biologische meshes duurder zijn dan synthetische varianten.
Een kosten-batenanalyse op lange termijn is op dit moment niet mogelijk. Op korte termijn zijn de kosten van biologische meshes hoger. Het onderliggende idee achter het gebruik van een biologisch implantaat is het potentieel verminderen van complicaties die geassocieerd worden met synthetische meshes, zoals erosie en chronische infecties. Deze complicaties manifesteren zich vaak pas op de lange termijn en kunnen leiden tot extra medische kosten. In theorie zou het gebruik van een biologisch implantaat deze kosten kunnen beperken, maar hiervoor ontbreekt momenteel wetenschappelijk bewijs.
Concluderend kan gesteld worden dat er onvoldoende gegevens beschikbaar zijn om een onderbouwde kostenoverweging te maken bij de keuze tussen biologische en synthetische meshes voor deze ingreep.
Gelijkheid ((health) equity/equitable)
Niet van toepassing.
Aanvaardbaarheid:
Ethische aanvaardbaarheid
De interventie lijkt aanvaardbaar voor betrokkenen. De werkgroep voorziet geen ethische bezwaren, mits patiënten goed geïnformeerd worden over de voor- en nadelen van het gebruik van synthetische en biologische mesh, zodat zij een weloverwogen keuze via shared- decision making kunnen maken.
Duurzaamheid
Er zijn geen studies beschikbaar over duurzaamheidsaspecten van het gebruik van synthetische versus biologische mesh.
Haalbaarheid
De interventie lijkt haalbaar en maakt onderdeel uit van de standaardzorg in Nederland.
Rationale van de aanbeveling: weging van argumenten voor en tegen de interventies
Momenteel is er geen gerandomiseerd onderzoek voor het gebruik van biologische of synthetische mesh en zijn de aanbevelingen gebaseerd op vijf cohortstudies, waarvan er één prospectief en vier retrospectief waren, waarbij beide meshes met elkaar werden vergeleken. Het is nog niet duidelijk wat de lange termijns resultaten van biologische mesh zijn, terwijl het bekend is de lange termijns resultaten van synthetische mesh goed zijn. De werkgroep spreekt daarom een voorkeur uit voor synthetische mesh.
Eindoordeel:
Sterke aanbeveling voor het gebruik van synthetische mesh.
Onderbouwing
For a rectopexy, a mesh is used to secure or lift the rectum. Typically, a synthetic (polypropylene) mesh is used for this purpose. In recent years, there has been an increase in aversion to synthetic mesh in the small pelvis, and interest in the use of biological mesh has grown. The question is whether biological or biosynthetic mesh is equally effective (in terms of recurrence) and indeed reduces (long-term) complications.
Summary of Findings
Population: Patients undergoing a laparoscopic ventral rectopexy for the treatment of a rectal prolapse prolaps
Intervention: Synthetic mesh
Control: Biological mesh, biosynthetic mesh (slowly resorbable synthetic), reinforced tissue matrix
|
Outcome
|
Study results and measurements |
Absolute effect estimates |
Certainty of the Evidence (Quality of evidence) |
Conclusions |
|
|
Synthetic Mesh |
Biological mesh |
||||
|
Recurrence of prolapse (critical)
|
Based on 3478 patients, from 5 studies |
The results could not be pooled and descriptive data is provided in the results section. Christen (2025) reported a higher recurrence rate in the biological mesh group compared to the synthetic mesh group. Drissi (2023) reported higher recurrence in the synthetic group, without statistical comparison. Evans (2015) found no significant difference in recurrence rates between mesh types. Fu (2017) reported a clinically relevant effect in favour of biological mesh on recurrence. Rogier-Mouzelas (2023) reported similar recurrence rates between groups based on clinical or radiologic confirmation. |
Very low Due to serious risk of bias and serious imprecision1 |
The evidence is very uncertain about the effect of synthetic mesh compared to biological mesh on recurrence of prolapse in patients undergoing laparoscopic ventral rectopexy. (Christen, 2025; Rogier-Mouzelas, 2023; Drissi, 2023; Evans, 2015; Fu, 2017)
|
|
|
Complications (including infections and erosion of the mesh) (critical)
|
Based on 3247 patients, from 4 studies |
Evans (2015) reported a clinically relevant effect in favour of biological mesh on mesh erosion. Christen (2025) reported higher rates of both minor and major complications in the synthetic mesh group; no mesh erosions were observed. Drissi (2023) and Rogier-Mouzelas (2023) reported no mesh-related complications in either group.
|
Very low Due to serious risk of bias and serious imprecision2 |
The evidence is very uncertain about the effect of synthetic mesh compared to biological mesh on complications, including mesh erosion. (Christen, 2025; Rogier-Mouzelas, 2023; Drissi, 2023; Evans, 2015)
|
|
|
Functional outcome measures (important) |
Based on 3478 patients from 5 studies |
Christen (2025) reported similar functional outcomes between groups using validated constipation and incontinence scores. Fu (2017) reported a clinically relevant effect in favour of biological mesh in patients with abnormal pudendal nerve latency. Drissi (2023) reported improved bowel function in both groups, with fewer de novo symptoms in the biological group. Rogier-Mouzelas (2023) and Evans (2015) reported symptomatic improvement in both groups without the use of validated measurement tools. |
Very low Due to serious risk of bias and serious imprecision3 |
The evidence is very uncertain about the effect of synthetic mesh compared to biological mesh on functional outcomes in patients undergoing laparoscopic ventral rectopexy. (Christen, 2025; Rogier-Mouzelas, 2023; Drissi, 2023; Evans, 2015; Fu, 2017 |
|
|
Pain and dyspareunia (important) |
- |
- |
No GRADE (No evidence was found) |
- |
|
1. Risk of bias: observational design, lack of adjustment; Serious imprecision: small sample sizes
2. Risk of bias: incomplete reporting in some studies; Serious imprecision: few events, small samples
3. Risk of bias: non-validated tools, subjective reporting; Serious imprecision: no consistent effect sizes reported
Description of studies
A total of five studies were included in the analysis of the literature. Important study characteristics and results are summarized in table 2. The assessment of the risk of bias is summarized in the risk of bias tables (under the tab ‘Evidence tabellen’). All five included studies compared synthetic mesh with biological mesh. No studies were identified that directly compared synthetic mesh with biosynthetic mesh (slowly resorbable synthetic mesh) or reinforced tissue matrix.
Christen (2025) conducted a prospective international multicenter cohort study comparing synthetic mesh (n=220) to biological mesh (n=140) in 360 patients undergoing laparoscopic ventral mesh rectopexy (LVMR). The study aimed to evaluate the safety and effectiveness of biological versus synthetic mesh in LVMR. The study population consisted of patients undergoing elective laparoscopic ventral mesh rectopexy. The authors did not explicitly report inclusion or exclusion criteria. Patients were not randomized, but baseline characteristics such as age, sex, BMI, and prolapse symptoms were reported and largely comparable between groups. Most patients were women (96%), with a mean age of 66.3 years (SD 14.33 years) in the synthetic group and 57.3 years (SD 16.87 years) in the biologic group. The mean follow-up duration was 21.5 months (synthetic) and 13.9 months (biologic).
The retrospective cohort study by Rogier-Mouzelas (2023) aimed to compare postoperative outcomes between biological and synthetic mesh in a real-world setting. The study included patients who underwent laparoscopic ventral mesh rectopexy between 2017 and 2021; the authors did not specify formal inclusion or exclusion criteria. Follow-up data were available for 12 months in both groups. Baseline characteristics including age, sex, ASA classification, and prolapse type were comparable between groups. The primary outcomes were recurrence and functional improvement. The 415 patients undergoing laparoscopic ventral mesh rectopexy with either synthetic mesh (n=345) or biological mesh (n=70). The mean age was 63 years in the synthetic mesh group, of whom 97% were female, and 65 years in the biological mesh group, of whom 90% were female. Median follow-up was 12 months in both groups.
Drissi (2023) conducted a retrospective cohort study. The objective was to compare outcomes of robotic VMR with biological mesh to conventional laparoscopic VMR with synthetic mesh. The study included patients undergoing surgery for posterior pelvic floor disorders between 2015 and 2020. No explicit inclusion or exclusion criteria were reported. Baseline variables such as age, comorbidities, and prolapse symptoms were similar between groups. Median follow-up was 14.3 months. Outcome measures included recurrence, postoperative complications, and new-onset symptoms. The study included 269 patients undergoing laparoscopic ventral mesh rectopexy with synthetic mesh (n=133) or robotic ventral mesh rectopexy with biological mesh (n=136).
Evans (2015) performed a large multicenter retrospective study across five centers. The aim was to assess real-world outcomes of LVMR with either synthetic or biological mesh. Patients undergoing elective LVMR at five UK centers were included between 2007 and 2012. Specific exclusion criteria were not detailed. The groups differed somewhat at baseline in terms of center-specific mesh preferences, but overall demographics were comparable. The average follow-up was 21 months (range 1–52 months). Outcome measures included recurrence, reoperation, mesh erosion, and patient-reported symptom resolution. The study included 2203 patients undergoing laparoscopic ventral rectopexy: 1764 received synthetic mesh and 439 received biological mesh. Mean follow-up was 21 months (range 1–52 months).
The retrospective cohort study by Fu (2017) aimed to compare outcomes between synthetic and biological mesh in posterior compartment prolapse, with particular attention to patients with impaired pudendal nerve function. Patients undergoing LVMR from 2009 to 2014 were included. The authors did not explicitly report exclusion criteria. The mean follow-up was 22.3 months. Main outcomes were recurrence, defecatory symptoms, and mesh-related complications. Subgroup analysis was performed in patients with abnormal pudendal nerve terminal motor latency (PNTML). The study included outcomes in 231 patients with posterior compartment prolapse treated with laparoscopic ventral rectopexy using either synthetic mesh or biological grafts. With an average age at time of surgery of 63.5 years.
Table 2. Characteristics of included studies
|
Study reference |
Participants |
Comparison |
Follow-up |
Outcome measures |
Comments |
Risk of bias (per outcome measure)* |
|
Christen (2025) |
360 patients, 96% female, Intervention: n= 220, 66.3 year (SD 14.33) Control: n = 140, mean age 57.3 year (SD 16.87) |
Intervention: synthetic mesh during VMR Control: Biologic mesh
|
Intervention: 21.5 months
Control: 13.9 months |
Recurrence of prolapse, Complications (including mesh erosion), Functional outcomes |
No conflicts of interest. |
Some concerns |
|
Drissi (2023) |
269 patients with posterior pelvic floor disorders Intervention: n= 62.4 years (SD 12.9) Control: n=61.3 (SD 14.1) |
Intervention: Laparoscopic synthetic mesh rectopexy Control: Robotic biologic mesh |
Median 14.3 months |
Recurrence of prolapse, Complications, Functional outcomes |
Source of funding not reported. No conflicts of interest. |
High |
|
Evans (2015) |
2203 patients Intervention: n=1764 Control: n=439; international multicenter study |
Intervention: Synthetic Control: Biologic mesh for LVR |
Mean 21 months (range 1–52) |
Recurrence of prolapse, Complications (including mesh erosion), Functional outcomes |
Source of funding not declared. No conflicts of interest declared. |
High |
|
Fu (2017) |
231 patients with posterior compartment prolapse |
Intervention: Synthetic Control: Biologic graft in LVR |
Mean 22.3 months |
Recurrence of prolapse, Complications, Functional outcomes |
Source of funding not declared. No conflicts of interest declared. |
High |
|
Rogier-Mouzelas (2023) |
415 patients Intervention: n=345 Control: n=70 ; mean age: 63 yrs; 89% female |
Intervention: Synthetic mesh in laparoscopic ventral mesh rectopexy Control: biologic mesh |
Median 12 months |
Recurrence of prolapse, Complications, Functional outcomes |
Source of funding not reported. No conflicts of interest. |
Low |
*For further details, see risk of bias table in the appendix
Results
The way results were reported varied per study. Therefore, pooling of results was not possible. When 95% CI was not reported is not shown in the description below.
Recurrence of prolapse (critical)
All five studies reported on the recurrence of prolapse. Most studies found no statistically significant difference between biological and synthetic mesh, although one study (Fu 2017) showed a higher risk of recurrence with synthetic mesh. Definitions of recurrence and follow-up durations varied.
- Christen 2025 reported clinical recurrence in twelve patients with synthetic mesh (5.5%) and thirteen patients with biological mesh (9.3%) (p=0.20). The higher recurrence in the biological group was predominantly seen in patients where absorbable sutures were used. The authors emphasized the possible role of suture type in recurrence.
- Drissi (2023): Recurrence was observed in 13.0% of patients who underwent laparoscopic VMR (n=222) with synthetic mesh and 8.5% of those who had robotic VMR with biological mesh (n=47). Recurrence was not clearly defined, and no statistical comparison was reported.
- Evans (2015): In this large retrospective cohort (n=2203), recurrence was assessed via patient records and surgeon follow-up. The authors reported no significant differences in recurrence rates between the mesh types, though exact percentages were not disclosed.
- Fu (2017): Recurrence occurred in 27 of all patients (11.7%), 25 (22.1%) of ful-thickness prolapse patients and 2 (1.7%) of rectocele, internal interception or SRUS patients. Synthetic mesh was associated with a significantly increased recurrence risk (hazard ratio [HR] 4.24, 95% CI 1.10–16.3, p=0.036), especially among patients with abnormal pudendal nerve terminal motor latency.
- Rogier-Mouzelas 2023: In this retrospective cohort recurrence occurred in 41 patients with synthetic mesh (12.0%) vs. 7 patients with biological mesh (10.0%). Recurrence was defined as recurrent symptoms confirmed by clinical or radiologic assessment.
Complications (including infections and erosion of the mesh) (critical)
All studies reported on complications. Mesh erosion was specifically mentioned in three studies and occurred more frequently with synthetic mesh. Reported complications varied slightly between studies but were generally low across both mesh types. Mesh erosion was observed only in the study by Evans (2015), while other studies reported either no mesh-related complications or only minor postoperative issues such as urinary tract infections or port-site hernias.
- Christen (2025): Minor complications (Clavien-Dindo grade I and II) were seen in 20 synthetic patients (9.1%) vs. 7 biological patients (5.0%), while major complications (Clavien-Dindo grade III and higher) occurred in 4 synthetic patients 1.8% vs. 1 biological patient (0.7%). No mesh-related erosion or fistulation was observed. Surgical complications included urinary tract infection and port-site hernia.
- Drissi (2023): No mesh-related complications were reported in either group, and no reoperations were needed for mesh-related issues. Exact numbers were not reported.
- Evans (2015): Mesh erosion occurred in 42 patients treated with synthetic mesh (2.4%) and in 3 patients treated with biological mesh (0.7%). The difference was statistically significant and led the authors to recommend biological mesh in patients at higher erosion risk.
- Fu (2017): No serious adverse events or mesh erosions were observed. One case of transient urinary retention was reported in the synthetic mesh group.
- Rogier-Mouzelas (2023): No mesh-related complications (erosion, infection, or fistulas) were reported in either group.
Functional outcome measures (important)
All studies reported improvement in functional outcomes postoperatively, such as constipation, fecal incontinence, and obstructed defecation. Measurement tools varied, and not all studies used validated scoring systems.
- Christen (2025): Functional outcomes were measured using the Cleveland Clinic Constipation Score and the Vaizey-Wexner Incontinence Score. Both groups showed similar improvement postoperatively, with no significant difference between synthetic and biological mesh.
- Drissi (2023): Significant improvement in obstructive defecation and continence symptoms was observed in both groups. Patients in the biological mesh group experienced fewer new (de novo) symptoms postoperatively.
- Evans (2015): Functional outcomes were not formally scored but described as satisfactory in the majority of patients based on surgeon assessment.
- Fu (2017): Improvement in defecatory symptoms was noted in both groups. In a subgroup analysis, patients with abnormal pudendal nerve latency who received biological mesh had significantly better functional outcomes.
- Rogier-Mouzelas (2023): Subjective improvement in constipation and incontinence was reported in both groups. No validated questionnaires were used, but symptom resolution was documented at follow-up visits.
Pain and dyspareunia (important)
Pain and dyspareunia was not reported.
A systematic review of the literature was performed to answer the following question(s):
What are the (un)favorable effects of biological, biosynthetic and reinforced tissue matrix compared with synthetic mesh in laparoscopic ventral rectopexy for the treatment of rectal prolapse?
Table 1. PICO
|
Patients |
Patients undergoing a laparoscopic ventral rectopexy for the treatment of a rectal prolapse prolaps |
|
Intervention |
Synthetic mesh |
|
Control |
Biological mesh, biosynthetic mesh (slowly resorbable synthetic), reinforced tissue matrix |
|
Outcomes |
Functional outcome measures (including fecal incontinence and residual obstipation), pain/dyspareunia, recurrence of prolapse, complications (including infections and erosion of the mesh) |
|
Other selection criteria |
Study design: systematic reviews, randomized controlled trials and observational studies. Publications from 2010 onward. |
Relevant outcome measures
The guideline panel considered recurrence of prolapse and complications as critical outcome measures for decision making; and functional outcomes and pain/dyspareunia as important outcome measures for decision making.
A priori, the guideline panel did not define the outcome measures listed above but used the definitions used in the studies.
The default boundaries as defined by GRADE were used: a 25% difference for dichotomous outcomes (RR< 0.8 or >1.25) and 0.5 SD for continuous outcomes as minimal clinically (patient) important difference.
Search and select (Methods)
A systematic literature search was performed by a medical information specialist using the following bibliographic databases: Embase.com and Ovid/Medline. Both databases were searched from 2010 to January 16th 2025 for systematic reviews, RCTs and observational studies. Systematic searches were completed using a combination of controlled vocabulary/subject headings (e.g., Emtree-terms, MeSH) wherever they were available and natural language keywords. The overall search strategy was derived from four primary search concepts: (1) laparoscopic ventral rectopexy; (2) rectal prolapse; (3) synthetic mesh; (4) biological mesh. Duplicates were removed using EndNote software. After deduplication a total of 697 records were imported for title/abstract screening.
Initially, fourteen studies were selected based on title and abstract screening. After reading the full text, eleven studies were excluded (see the exclusion table under the tab ‘Evidence tabellen’), and five studies were included.
- Christen S, Barron E, Gidl D, Khoo E, Potter M, Stuebi N, Geissbuehler V, Riss S, von Strauss M, Collie M, Steinemann DC. Is mesh related morbidity the real thread in ventral rectopexy? Results of a retrospective international multicentre comparative analysis of biologic versus synthetic mesh. Colorectal Dis. 2025 Jan;27(1):e17273. doi: 10.1111/codi.17273. PMID: 39781588.
- Drissi F, Rogier-Mouzelas F, Fernandez Arias S, Podevin J, Meurette G. Moving from Laparoscopic Synthetic Mesh to Robotic Biological Mesh for Ventral Rectopexy: Results from a Case Series. J Clin Med. 2023 Sep 4;12(17):5751. doi: 10.3390/jcm12175751. PMID: 37685818; PMCID: PMC10488879.
- Evans C, Stevenson AR, Sileri P, Mercer-Jones MA, Dixon AR, Cunningham C, Jones OM, Lindsey I. A Multicenter Collaboration to Assess the Safety of Laparoscopic Ventral Rectopexy. Dis Colon Rectum. 2015 Aug;58(8):799-807. doi: 10.1097/DCR.0000000000000402. PMID: 26163960.
- Fu CW, Stevenson AR. Risk Factors for Recurrence After Laparoscopic Ventral Rectopexy. Dis Colon Rectum. 2017 Feb;60(2):178-186. doi: 10.1097/DCR.0000000000000710. PMID: 28059914.
- Laitakari KE, Mäkelä-Kaikkonen JK, Kairaluoma M, Junttila A, Kössi J, Ohtonen P, Rautio TT. Redo ventral rectopexy: is it worthwhile? Tech Coloproctol. 2021 Mar;25(3):299-307. doi: 10.1007/s10151-020-02369-5. Epub 2020 Nov 5. PMID: 33151385; PMCID: PMC7932956.
- Rogier-Mouzelas F, Drissi F, Podevin J, Duchalais E, Meurette G. Anatomic and functional results of ventral biological mesh rectopexy for posterior pelvic floor disorders. J Visc Surg. 2023 Jun;160(3):188-195. doi: 10.1016/j.jviscsurg.2022.09.009. Epub 2022 Nov 4. PMID: 36344359.
- van der Schans EM, Verheijen PM, Broeders IAMJ, Consten ECJ. Ninety-day morbidity of robot-assisted redo surgery for recurrent rectal prolapse, mesh erosion and pelvic pain: lessons learned from 9 years' experience in a tertiary referral centre. Colorectal Dis. 2021 Dec;23(12):3205-3212. doi: 10.1111/codi.15979. Epub 2021 Nov 16. PMID: 34741395; PMCID: PMC9299011.
Risk of Bias tables
|
Author, year |
Selection of participants
Was selection of exposed and non-exposed cohorts drawn from the same population?
|
Exposure
Can we be confident in the assessment of exposure?
|
Outcome of interest
Can we be confident that the outcome of interest was not present at start of study?
|
Confounding-assessment
Can we be confident in the assessment of confounding factors?
|
Confounding-analysis
Did the study match exposed and unexposed for all variables that are associated with the outcome of interest or did the statistical analysis adjust for these confounding variables?
|
Assessment of outcome
Can we be confident in the assessment of outcome?
|
Follow up
Was the follow up of cohorts adequate? In particular, was outcome data complete or imputed?
|
Co-interventions
Were co-interventions similar between groups?
|
Overall Risk of bias
|
|
Definitely yes, probably yes, probably no, definitely no |
Definitely yes, probably yes, probably no, definitely no |
Definitely yes, probably yes, probably no, definitely no |
Definitely yes, probably yes, probably no, definitely no |
Definitely yes, probably yes, probably no, definitely no |
Definitely yes, probably yes, probably no, definitely no |
Definitely yes, probably yes, probably no, definitely no |
Definitely yes, probably yes, probably no, definitely no |
Low, Some concerns, High |
|
|
Christen, 2025 |
Definitely yes
Reason: Participants were selected from institutional practice. |
Definitely yes
Reason: Exposure clearly documented |
Definitely yes
Reason: selection criteria were used excluding participants with prior recurrence. |
Probably yes
Reason: indication, prior surgery, and ASA score were collected. |
Probably no
Reason: No matching; some statistical comparisons and subgroup analysis were performed, but no adjustment for confounders using multivariable regression. |
Probably yes
Reason: no independent or blinded assessors. |
Probably yes
Reason: No per group follow-up completeness or imputation method reported.
|
Probably yes
Reason: Surgical technique and concomitant procedures varied between centers. |
Some concerns |
|
Fu, 2017 |
Definitely yes
Reason: All patients treated by one surgeon in two centers. |
Definitely yes
Reason: Type of mesh recorded prospectively in surgical records. |
Probably yes
Reason: Exclusion of prior prolaps recurrence or prior posterior repair not clearly stated. |
Definitely yes
Reason: Multiple baseline factors were collected, including nerve testing and continence status. |
Definitely yes
Reason: Multivariable cox regression was performed. |
Definitely yes
Reason: Outcomes defined clearly. Defecography in unclear cases. |
Definitely yes
Reason: Median follow-up 47 months complete recurrence data for all patients. |
Probably yes
Reason: Some patients had colposusspension, differences across time periods but controlled in analysis
|
Low
|
|
Evens, 2015 |
Probably yes,
Reason: Included from 5 centers over 14 years. Time periods and indications may have varied. |
Definitely yes
Reason: Expose clearly recorded |
Probably yes
Reason: Prior symptoms at baseline not explicitly ruled out |
Probably yes
Reason: Some baseline data collected, but not all relevant variables for functional outcomes. |
Probably no
Reason: No matching or multivariable adjustment reported |
Probably yes
Reason: Mesh complications reported, no mention of blinded assessors |
Probably no
Reason: Follow-up limited, no imputation |
Definitely yes
Reason: Likely variable across centers and time. |
High |
|
Drissi, 2023 |
Probably no
Reason: Exposure groups from different time periods |
Definitely yes,
Reason: Surgical approach and type of mesh recorded accurately. |
Probably yes
Reason: No indication that outcomes like recurrence or symptoms were absent at baseline |
Probably no
Reason: some baseline data recorded, not all relevant to outcomes. |
Probably no
Reason: Groups not matched, not adjusted in analysis |
Probably yes
Reason: Follow up visits and assessments documented but not blinded |
Probably no
Reason: Scheduled follow up to one year. Follow-up completeness unclear. |
Probably no
Reason: Anterior fixation varied between groups (39% vs. 6,4%) |
High |
|
Rogier-Mouzelas, 2023 |
Definitely yes
Reason: Patients from the same center; mesh type linked to time period. |
Definitely yes
Reason: Mesh type documented accurately. |
Probably yes
Reason: No confirmation of absence of outcome at baseline |
Definitely yes
Reason: Baseline clinical data were collected |
Probably no
Reason: No matching or regression adjustment |
Definitely yes
Reason: Assessed in clinic or by imaging. |
Probably yes
Reason: No data on loss to follow up |
Probably no
Reason: Different approach unclear whether anterior repairs differed. |
High |
Table of excluded studies
|
Reference |
Reason for exclusion |
|
Alam NN, Narang SK, Köckerling F, Daniels IR, Smart NJ. Rectopexy for Rectal Prolapse. Front Surg. 2015 Oct 19;2:54. doi: 10.3389/fsurg.2015.00054. PMID: 26539438; PMCID: PMC4609832. |
No comparison |
|
Balla A, Quaresima S, Smolarek S, Shalaby M, Missori G, Sileri P. Synthetic Versus Biological Mesh-Related Erosion After Laparoscopic Ventral Mesh Rectopexy: A Systematic Review. Ann Coloproctol. 2017 Apr;33(2):46-51. doi: 10.3393/ac.2017.33.2.46. Epub 2017 Apr 28. Erratum in: Ann Coloproctol. 2017 Dec;33(6):253. doi: 10.3393/ac.2017.33.6.253. PMID: 28503515; PMCID: PMC5426201. |
No comparison |
|
Lobb HS, Kearsey CC, Ahmed S, Rajaganeshan R. Suture rectopexy versus ventral mesh rectopexy for complete full-thickness rectal prolapse and intussusception: systematic review and meta-analysis. BJS Open. 2021 Jan 8;5(1):zraa037. doi: 10.1093/bjsopen/zraa037. PMID: 33609376; PMCID: PMC7893464. |
No comparison |
|
Smart NJ, Pathak S, Boorman P, Daniels IR. Synthetic or biological mesh use in laparoscopic ventral mesh rectopexy--a systematic review. Colorectal Dis. 2013 Jun;15(6):650-4. doi: 10.1111/codi.12219. PMID: 23517144. |
No comparison |
|
van der Schans EM, Boom MA, El Moumni M, Verheijen PM, Broeders IAMJ, Consten ECJ. Mesh-related complications and recurrence after ventral mesh rectopexy with synthetic versus biologic mesh: a systematic review and meta-analysis. Tech Coloproctol. 2022 Feb;26(2):85-98. doi: 10.1007/s10151-021-02534-4. Epub 2021 Nov 23. PMID: 34812970; PMCID: PMC8763765. |
No comparison |
|
Gleditsch D, Wexels WA, Nesbakken A. Surgical options and trends in treating rectal prolapse: long-term results in a 19-year follow-up study. Langenbecks Arch Surg. 2018 Dec;403(8):991-998. doi: 10.1007/s00423-018-1728-4. Epub 2018 Nov 10. PMID: 30415286. |
No comparison |
Beoordelingsdatum en geldigheid
Publicatiedatum : 13-07-2026
Beoordeeld op geldigheid : 13-07-2026
Samenstelling werkgroep
Voor het ontwikkelen van de richtlijnmodule is in 2024 een multidisciplinair cluster ingesteld. Het cluster Bekkenbodem en proctologie bestaat uit meerdere richtlijnen (zie hier de actuele clusterindeling). De stuurgroep bewaakt het proces van modulair onderhoud binnen het cluster. De expertisegroepsleden brengen hun expertise in, indien nodig. De volgende personen uit het cluster zijn betrokken geweest bij de herziening van deze module:
Clusterstuurgroepleden
- F.M.J. (Frank) Martens, uroloog, Radboud UMC te Nijmegen, NVU
- M.B.E. (Maaike) Gerritse, gynaecoloog, Ziekenhuis Gelderse Vallei te Ede, NVOG
- C.F. (Claire) la Chapelle, gynaecoloog, VieCuri Medisch Centrum te Venlo, NVOG
- G.S.A. (Gabor) Abis, gastro-intestinaal en oncologisch chirurg, Meander Medisch Centrum te Amersfoort, NVvH
- J.C. (Jacco) de Pooter, dermatoloog, Isala Klinieken, NVDV
Betrokken clusterexpertisegroepleden
- A.L.A. (Bob) Bloemendaal, chirurg, Reinier de Graaf Gasthuis te Delft, NVvH
- Mevr. S. (Stephanie) Breukink, colorectaal en oncologisch chirurg, Maastricht UMC te Maastricht, NVvH
Met ondersteuning van
- I. (Iméze) Hieltjes, junior adviseur, Kennisinstituut van de Federatie Medisch Specialisten
- J.M. (Janneke) Schultink, adviseur, Kennisinstituut van de Federatie Medisch Specialisten
- A.L.A (Andrea) Kortlever- van der Spek, senior-adviseur, Kennisinstituut van de Federatie Medisch Specialisten
- I.M (Irina) Mostovaya, senior-adviseur, Kennisinstituut van de Federatie Medisch Specialisten
- E. (Esther) van der Bijl, medisch informatiespecialist, Kennisinstituut van de Federatie Medisch Specialisten
Belangenverklaringen
Een overzicht van de belangen van de clusterleden en het oordeel over het omgaan met eventuele belangen vindt u in onderstaande tabel. De ondertekende belangenverklaringen zijn op te vragen bij het secretariaat van het Kennisinstituut van de Federatie Medisch Specialisten via secretariaat@kennisinstituut.nl.
Gemelde (neven)functies en belangen stuurgroepleden
|
Naam |
Hoofdfunctie |
Nevenwerkzaamheden |
Persoonlijke financiële belangen |
Persoonlijke relaties |
Extern gefinancierd onderzoek |
Intellectuele belangen en reputatie |
Overige belangen |
Datum |
Restrictie |
|
Frank Martens *Duo voorzitter |
Uroloog, Radboudumc, 1.0 Fte |
Geen |
In 2021 twee sprekersvergoedingen van circa 1000 euro ontvangen voor symposia die gesponsord werden door Astellas Pharma (transparantieregister). |
Geen |
*Bedrijf: Blue Wind (financier) OASIS, overactieve blaas/urge-incontinentie, stimulatie (implantaat) n. tibialis posterior. Multicenter studie. Rol: Investigor Nijmegen oorspronkelijke studie, PI Nijmegen follow-up studie (multicenter studie). Organisatie: ZonMW (financier) *Bedrijf: Goodlife (aanvullende financiering) GETSBI, GAG-spoelingen bij interstitiële cystitis/blaaspijnsyndroom met Hunnerse laesies. Multicenter studie Rol: investigator Nijmegen (niet-PI) *Bedrijf: Goodlife (financier) GT racing studie, GAG-spoelingen bij recidiverende urineweginfecties Multicenter studie. Rol: investigator (niet-PI) *Bedrijf: Saluda Medical (financier) CARE, sacrale neuromodulatie voor overactieve blaas/urge-incontinentie Multicenter studie. Rol: PI Nijmegen (multicenter studie) Organisatie: European Association of Urology Research Foundation *Bedrijf: Boston Scientific (financier) SATURN, registry implantaten mannelijke stressincontinentie Multicenter registry. Rol: lid steering committee, PI Nijmegen. |
Geen |
Geen |
13-10-2023 |
Bij aanvang van de eerste cyclus is de heer Martens betrokken bij drie extern gefinancierde onderzoeken die mogelijk belangenverstrengeling opleveren, namelijk OASIS, CARE en SATURN studies. Voor de onderwerpen blaas/urge-incontinentie, stimulatie (implantaat) n. tibialis posterior, sacrale neuromodulatie en implantaten voor mannelijke stressincontinentie worden restricties ten aanzien van besluitvorming opgelegd. De heer Martens zal geen schrijver zijn van modules over deze onderwerpen en niet meedoen bij het formuleren van aanbevelingen. Wel zal hij meediscussiëren over de inhoud van modules. Dit wordt vastgelegd in notulen van vergaderingen. |
|
Maaike Gerritse *Duo voorzitter |
Gynaecoloog vrijgevestigd, Ziekenhuis Gelderse Vallei PhD onderzoeker Radboudumc Nijmegen |
Gynaecoloog: betaald PhD onderzoeker: onbetaald |
Geen |
Geen |
Geen |
Geen |
Geen |
2-11-2023 |
Geen |
|
Claire la Chapelle |
Gyneacoloog in het VieCuri ziekenhuis |
Geen |
Geen |
Geen |
SAM studie 5 jaars follow up jPI gelden RadboudUMC Sacrospinale fixatie versus manchester Fothergill bij prolaps. |
Geen |
Geen |
28-11-2023 |
Geen |
|
Gabor Abis |
Gastro-intestinaal en oncologisch chirurg in het Meander MC Amersfoort |
Bariatrisch chirurg bij Weightworks, ZBC |
Geen |
Geen |
Geen |
Deelname aan Protex studie (PI prof Consten, directe collega). Vergelijking huidige standaard prolene mat met de OviTex 1S door middel van een non-inferiority studie. |
Geen |
10-04-2023 |
Geen restricties. Bij aanvang van de eerste studie is de heer Abis uitvoerend betrokken bij de Protex studie (geen PI). |
|
Jacco de Pooter |
Dermatoloog, Isala Klinieken
|
Geen |
Geen |
Geen |
Geen |
Geen |
Geen |
12-03-2023 |
Geen |
Gemelde (neven)functies en belangen betrokken expertisegroepleden
|
Naam |
Hoofdfunctie |
Nevenwerkzaamheden |
Persoonlijke financiële belangen |
Persoonlijke relaties |
Extern gefinancierd onderzoek |
Intellectuele belangen en reputatie |
Overige belangen |
Datum |
Restrictie |
|
Stephanie Breukink |
Colorectaal en oncologisch chirurg, Maastricht UMC |
Unrestricted grant for research from: • A.M.I. Agency for Medical Innovations GmbH • Biolitec / CeramOptec SIA • Karl Storz SE & Co. KG 2024- present ECMT European Continuining Medical Training (Board member) |
Geen |
Geen |
*A.M.I. Agency for Medical Innovations GmbH/ Biolitec,CeramOptec SIA/ Karl Storz SE & Co. KG: onderzoek over perianale fistels, projectleider. |
Geen |
Geen |
22-05-2025 |
Geen |
|
Bob Bloemendaal |
Chirurg, Reinier de Graaf Gasthuis |
Proctor en consultant voor: 1. Intuitive Surg. 2. TelaBio 3. FascioTens GmbH 4. Medtronic |
Proctor en consultant voor: 1. Intuitive Surg. 2. TelaBio 3. FascioTens GmbH 4. Medtronic |
Geen |
Geen |
Protex trial, deze studie onderzoekt kunststof vs biologische mesh - uitvoerend onderzoeker en aanspreekpunt op locatie. Medeauteur op uiteindelijke publicatie. |
Geen |
4-05-2023 |
De heer Bloemendaal zijn werkzaamheden als proctor/consultant hebben directe raakvlakken met de onderwerpen synthetische en biologische mesh welke worden behandeld in de te updaten modules. Er worden restricties ten aanzien van besluitvorming van deze onderwerpen opgelegd. De heer Bloemendaal zal geen schrijver zijn van modules over deze onderwerpen en niet meedoen bij het formuleren van aanbevelingen. Wel zal hij meediscussiëren over de inhoud van modules. Dit wordt vastgelegd in notulen van vergaderingen. |
Inbreng patiëntenperspectief
Kwalitatieve raming van mogelijke financiële gevolgen in het kader van de Wkkgz
Bij de richtlijnmodule voerden de clusterleden conform de Wet kwaliteit, klachten en geschillen zorg (Wkkgz) een kwalitatieve raming uit om te beoordelen of de aanbevelingen mogelijk leiden tot substantiële financiële gevolgen. Bij het uitvoeren van deze beoordeling is de richtlijnmodule op verschillende domeinen getoetst (zie het stroomschema bij Werkwijze).
|
Module |
Uitkomst raming |
Toelichting |
|
Mesh voor behandeling rectumprolaps door LVR |
Geen financiële gevolgen |
Uit de toetsing volgt dat de aanbeveling niet breed toepasbaar is (<5.000 patiënten) en zal daarom naar verwachting geen substantiële financiële gevolgen hebben voor de collectieve uitgaven. |
Werkwijze
Voor meer details over de gebruikte richtlijnmethodologie verwijzen wij u naar de Werkwijze. Relevante informatie voor de ontwikkeling/herziening van deze richtlijnmodule is hieronder weergegeven.
Zoekverantwoording
Zoekopbrengst
|
|
EMBASE |
OVID/MEDLINE |
Ontdubbeld |
|
SR |
62 |
43 |
80 |
|
RCT |
175 |
51 |
193 |
|
Observationele studies |
383 |
178 |
424 |
|
Totaal |
620 |
272 |
697* |
*in Rayyan
Zoekstrategie - 16 januari 2025
Embase.com
|
No. |
Query |
Results |
|
#1 |
'rectum prolapse'/exp OR 'ventral mesh rectopexy'/exp OR 'proctopexy'/exp OR (((rectal* OR rectum OR recti* OR rectosigmoid* OR anus OR anal) NEAR/3 fixat*):ti,ab,kw) OR (('rectum'/exp OR 'anus'/exp OR rectum:ti,ab,kw OR rectal*:ti,ab,kw OR recti*:ti,ab,kw OR rectosigmoid*:ti,ab,kw OR anus:ti,ab,kw OR anal:ti,ab,kw) AND ('prolapse'/exp OR 'procident*':ti,ab,kw OR 'prolaps*':ti,ab,kw)) OR (((rect* OR anorect* OR anus OR anal) NEAR/3 (prolaps* OR intussuscept* OR invaginat* OR procident*)):ti,ab,kw) OR proctoptos*:ti,ab,kw OR archoptos*:ti,ab,kw OR proctopex*:ti,ab,kw OR rectopex*:ti,ab,kw |
14308 |
|
#2 |
'synthetic mesh'/exp OR 'surgical mesh'/exp OR (((synthetic* OR '3d max' OR bio* OR 'c-qur' OR 'gore infinit' OR 'gore-tex dual' OR kugel OR mersuture OR surgipro OR phs OR proceed OR polyform OR prolene OR restorelle OR surgipro OR tigr OR veritas) NEAR/3 mesh*):ti,ab,kw) OR '4ddome':ti,ab,kw OR 'aigisrx':ti,ab,kw OR 'adhesix':ti,ab,kw OR 'alloderm':ti,ab,kw OR 'allomax':ti,ab,kw OR 'angimesh':ti,ab,kw OR 'cicat':ti,ab,kw OR 'collamend':ti,ab,kw OR 'composix ex patch':ti,ab,kw OR 'composix kugel':ti,ab,kw OR 'composix kugel patch':ti,ab,kw OR 'composix l/p':ti,ab,kw OR 'crurasoft':ti,ab,kw OR 'dermmatrix':ti,ab,kw OR 'dermamatrix':ti,ab,kw OR 'dual mesh':ti,ab,kw OR 'dualmesh':ti,ab,kw OR 'dulex':ti,ab,kw OR 'dynamesh cicat':ti,ab,kw OR 'dynamesh endolap':ti,ab,kw OR 'dynamesh ipoom':ti,ab,kw OR 'dynamesh ipst':ti,ab,kw OR 'dynamesh lichtenstein':ti,ab,kw OR 'dynamesh pp':ti,ab,kw OR 'dynamesh':ti,ab,kw OR 'dynamesh ipom':ti,ab,kw OR 'epidisc':ti,ab,kw OR 'evolution p3em':ti,ab,kw OR 'faslata':ti,ab,kw OR 'flex hd':ti,ab,kw OR 'flexhd':ti,ab,kw OR 'flexhd structural':ti,ab,kw OR 'fortagen':ti,ab,kw OR 'fortisan':ti,ab,kw OR 'fortisan fabric':ti,ab,kw OR 'glucamesh':ti,ab,kw OR 'gore-tex dualmesh':ti,ab,kw OR 'hi-tex':ti,ab,kw OR 'hi-tex endo ip':ti,ab,kw OR 'hi-tex parp mp':ti,ab,kw OR 'hi-tex parp mp3':ti,ab,kw OR 'hi-tex parp ph':ti,ab,kw OR 'hi-tex parp ph2':ti,ab,kw OR 'hi-tex parp px':ti,ab,kw OR 'hermesh':ti,ab,kw OR 'hermesh 0':ti,ab,kw OR 'hermesh 10':ti,ab,kw OR 'hermesh 3':ti,ab,kw OR 'hermesh 4':ti,ab,kw OR 'hermesh 5':ti,ab,kw OR 'hermesh 6':ti,ab,kw OR 'hermesh 7':ti,ab,kw OR 'hermesh 8':ti,ab,kw OR 'hermesh 9':ti,ab,kw OR 'hertra':ti,ab,kw OR 'hertra 1':ti,ab,kw OR 'hertra 2':ti,ab,kw OR 'hertra 2a':ti,ab,kw OR 'hertra 6':ti,ab,kw OR 'hertra 6a':ti,ab,kw OR 'hertra 7':ti,ab,kw OR 'hertra 9':ti,ab,kw OR 'hertra 9a':ti,ab,kw OR 'infinit mesh':ti,ab,kw OR 'intepro lite':ti,ab,kw OR 'intexen':ti,ab,kw OR 'kugel patch':ti,ab,kw OR 'lichtenstein (medical device)':ti,ab,kw OR 'mersilene polyester fiber suture':ti,ab,kw OR 'motifmesh':ti,ab,kw OR 'mycromesh':ti,ab,kw OR 'mycromesh plus':ti,ab,kw OR 'neoveil':ti,ab,kw OR 'omyra':ti,ab,kw OR 'optilene mesh lp':ti,ab,kw OR 'orthomesh':ti,ab,kw OR 'ovitex prs':ti,ab,kw OR 'parietene':ti,ab,kw OR 'parietene composite':ti,ab,kw OR 'parietene flat sheet':ti,ab,kw OR 'parietene macroporous':ti,ab,kw OR 'parietex progrip':ti,ab,kw OR 'parietex composite':ti,ab,kw OR 'pelvicol':ti,ab,kw OR 'pelvisoft':ti,ab,kw OR 'pelvitex':ti,ab,kw OR 'perfix':ti,ab,kw OR 'peri-strips dry':ti,ab,kw OR 'permacol':ti,ab,kw OR 'physiomesh':ti,ab,kw OR 'polysoft hernia patch':ti,ab,kw OR 'polypropylene hernia system':ti,ab,kw OR 'polysoft mesh':ti,ab,kw OR 'progrip':ti,ab,kw OR 'prolite':ti,ab,kw OR 'prolene 3d patch':ti,ab,kw OR 'prolene hernia system':ti,ab,kw OR 'prolene polypropylene hernia system':ti,ab,kw OR 'prolene soft':ti,ab,kw OR 'prolene mesh':ti,ab,kw OR 'prolite ultra':ti,ab,kw OR 'restorelle':ti,ab,kw OR 'restorelle a':ti,ab,kw OR 'restorelle directfix':ti,ab,kw OR 'restorelle l':ti,ab,kw OR 'sepramesh':ti,ab,kw OR 'sepramesh ip':ti,ab,kw OR 'sepramesh ip composite':ti,ab,kw OR 'soft mesh':ti,ab,kw OR 'softmesh':ti,ab,kw OR 'strattice':ti,ab,kw OR 'surgimesh (surgical mesh)':ti,ab,kw OR 'surgimesh wn':ti,ab,kw OR 'surgimesh xb':ti,ab,kw OR 'surgipro mesh clear hernia patch':ti,ab,kw OR 'symbotex':ti,ab,kw OR 'telamax':ti,ab,kw OR 'tigr matrix':ti,ab,kw OR 'tephaflex':ti,ab,kw OR 'tiloop bra':ti,ab,kw OR 'timesh light':ti,ab,kw OR 'tissuemend':ti,ab,kw OR 'trelex':ti,ab,kw OR 'trelex natural':ti,ab,kw OR 'tutomesh':ti,ab,kw OR 'tutopatch':ti,ab,kw OR 'ultrapro':ti,ab,kw OR 'ventralex':ti,ab,kw OR 'ventralight':ti,ab,kw OR 'ventralight st':ti,ab,kw OR 'ventrio':ti,ab,kw OR 'ventrio hernia patch':ti,ab,kw OR 'ventrio st':ti,ab,kw OR 'vitamesh':ti,ab,kw OR 'vypro':ti,ab,kw OR 'vypro ii':ti,ab,kw OR 'vyproii':ti,ab,kw OR 'metallic multi-purpose surgical mesh':ti,ab,kw OR 'surgical mesh':ti,ab,kw |
33442 |
|
#3 |
'bioabsorbable mesh'/exp OR 'biosynthetic mesh'/exp OR (((bioabsorb* OR biofiber OR bioresorb* OR kerecis OR biologic* OR phasix OR biosynthetic*) NEAR/3 mesh*):ti,ab,kw) OR 'bio-a tissue reinforcement prosthesis':ti,ab,kw OR 'collamend fm implant':ti,ab,kw OR 'dynamatrix':ti,ab,kw OR 'dynamatrix plus':ti,ab,kw OR 'enduragen':ti,ab,kw OR 'gore bio-a fistula plug':ti,ab,kw OR 'gore bio-a hernia plug':ti,ab,kw OR 'gore enform':ti,ab,kw OR 'galaflex':ti,ab,kw OR 'galaflex scaffold':ti,ab,kw OR 'galaform 3d':ti,ab,kw OR 'matristem':ti,ab,kw OR 'miromesh':ti,ab,kw OR 'orthowrap':ti,ab,kw OR 'phasix':ti,ab,kw OR 'phasix st':ti,ab,kw OR 'proformix':ti,ab,kw OR 'seamguard':ti,ab,kw OR 'surgisis':ti,ab,kw OR 'surgisis gold':ti,ab,kw OR 'tenomend':ti,ab,kw OR 'trelliform':ti,ab,kw OR 'vivosorb':ti,ab,kw OR 'x-repair':ti,ab,kw OR 'xenmatrix':ti,ab,kw OR 'xenmatrix ab':ti,ab,kw OR 'xenmatrix surgical graft':ti,ab,kw OR 'xenform':ti,ab,kw OR 'reinforced tissue matrix':ti,ab,kw |
3400 |
|
#4 |
#2 OR #3 |
33807 |
|
#5 |
#1 AND #4 |
952 |
|
#6 |
(rect* NEAR/7 prolaps* NEAR/7 mesh*):ti,ab,kw |
298 |
|
#7 |
#5 OR #6 |
1120 |
|
#8 |
#7 AND [2010-2025]/py NOT (('animal'/exp OR 'animal experiment'/exp OR 'animal model'/exp OR 'nonhuman'/exp) NOT 'human'/exp) |
991 |
|
#9 |
'meta analysis'/exp OR 'meta analysis (topic)'/exp OR 'systematic review'/exp OR 'systematic review (topic)'/exp OR 'scoping review'/exp OR 'rapid review'/exp OR 'umbrella review'/exp OR 'cochrane database of systematic reviews'/jt OR 'network meta-analysis'/exp OR 'networkmeta analy*':ti,ab,kw OR 'networkmetaanaly*':ti,ab,kw OR metaanaly*:ti,ab,kw OR 'meta analy*':ti,ab,kw OR metanaly*:ti,ab,kw OR prisma:ti,ab,kw OR prospero:ti,ab,kw OR metaanali*:ti,ab,kw OR 'meta anali*':ti,ab,kw OR metanali*:ti,ab,kw OR (((systemati* OR scoping OR umbrella OR 'structured literature') NEAR/3 (review* OR overview*)):ti,ab,kw) OR (((structured OR systemic*) NEAR/3 (review* OR overview* OR synth*) NEAR/3 literature):ti,ab,kw) OR ((systemic* NEAR/1 review*):ti,ab,kw) OR (((systemati* OR literature OR database* OR 'data base*') NEAR/10 search*):ti,ab,kw) OR (((structured OR comprehensive* OR systemic*) NEAR/3 search*):ti,ab,kw) OR (((literature NEAR/3 (review* OR overview*)):ti,ab,kw) AND (search*:ti,ab,kw OR database*:ti,ab,kw OR 'data base*':ti,ab,kw)) OR (('data extraction*':ti,ab,kw OR 'data source*':ti,ab,kw) AND ('study selection*':ti,ab,kw OR 'studies selection*':ti,ab,kw)) OR ('search strateg*':ti,ab,kw AND 'selection criteria*':ti,ab,kw) OR ('data source*':ti,ab,kw AND 'data synth*':ti,ab,kw) OR medline*:ti,ab,kw OR pubmed*:ti,ab,kw OR 'pub med*':ti,ab,kw OR embase:ti,ab,kw OR cochrane*:ti,ab,kw OR (((critical* OR rapid*) NEAR/2 (review* OR overview* OR synth*)):ti) OR ((((critical* OR rapid*) NEAR/3 (review* OR overview* OR synth*)):ab) AND (search*:ab OR database*:ab OR 'data base*':ab)) OR metasynth*:ti,ab,kw OR 'meta synth*':ti,ab,kw OR 'review* of review*':ti,ab,kw |
1114028 |
|
#10 |
'clinical trial'/exp OR 'randomization'/exp OR 'single blind procedure'/exp OR 'double blind procedure'/exp OR 'crossover procedure'/exp OR 'placebo'/exp OR 'prospective study'/exp OR rct:ab,ti OR random*:ab,ti OR 'single blind':ab,ti OR 'randomised controlled trial':ab,ti OR 'randomized controlled trial'/exp OR placebo*:ab,ti |
4188767 |
|
#11 |
'major clinical study'/de OR 'clinical study'/de OR 'case control study'/de OR 'family study'/de OR 'longitudinal study'/de OR 'retrospective study'/de OR 'prospective study'/de OR 'comparative study'/de OR 'cohort analysis'/de OR ((cohort NEAR/1 (study OR studies)):ab,ti) OR (('case control' NEAR/1 (study OR studies)):ab,ti) OR (('follow up' NEAR/1 (study OR studies)):ab,ti) OR (observational NEAR/1 (study OR studies)) OR ((epidemiologic NEAR/1 (study OR studies)):ab,ti) OR (('cross sectional' NEAR/1 (study OR studies)):ab,ti) |
8603376 |
|
#12 |
'case control study'/de OR 'comparative study'/exp OR 'control group'/de OR 'controlled study'/de OR 'controlled clinical trial'/de OR 'crossover procedure'/de OR 'double blind procedure'/de OR 'phase 2 clinical trial'/de OR 'phase 3 clinical trial'/de OR 'phase 4 clinical trial'/de OR 'pretest posttest design'/de OR 'pretest posttest control group design'/de OR 'quasi experimental study'/de OR 'single blind procedure'/de OR 'triple blind procedure'/de OR (((control OR controlled) NEAR/6 trial):ti,ab,kw) OR (((control OR controlled) NEAR/6 (study OR studies)):ti,ab,kw) OR (((control OR controlled) NEAR/1 active):ti,ab,kw) OR 'open label*':ti,ab,kw OR (((double OR two OR three OR multi OR trial) NEAR/1 (arm OR arms)):ti,ab,kw) OR ((allocat* NEAR/10 (arm OR arms)):ti,ab,kw) OR placebo*:ti,ab,kw OR 'sham-control*':ti,ab,kw OR (((single OR double OR triple OR assessor) NEAR/1 (blind* OR masked)):ti,ab,kw) OR nonrandom*:ti,ab,kw OR 'non-random*':ti,ab,kw OR 'quasi-experiment*':ti,ab,kw OR crossover:ti,ab,kw OR 'cross over':ti,ab,kw OR 'parallel group*':ti,ab,kw OR 'factorial trial':ti,ab,kw OR ((phase NEAR/5 (study OR trial)):ti,ab,kw) OR ((case* NEAR/6 (matched OR control*)):ti,ab,kw) OR ((match* NEAR/6 (pair OR pairs OR cohort* OR control* OR group* OR healthy OR age OR sex OR gender OR patient* OR subject* OR participant*)):ti,ab,kw) OR ((propensity NEAR/6 (scor* OR match*)):ti,ab,kw) OR versus:ti OR vs:ti OR compar*:ti OR ((compar* NEAR/1 study):ti,ab,kw) OR (('major clinical study'/de OR 'clinical study'/de OR 'cohort analysis'/de OR 'observational study'/de OR 'cross-sectional study'/de OR 'multicenter study'/de OR 'correlational study'/de OR 'follow up'/de OR cohort*:ti,ab,kw OR 'follow up':ti,ab,kw OR followup:ti,ab,kw OR longitudinal*:ti,ab,kw OR prospective*:ti,ab,kw OR retrospective*:ti,ab,kw OR observational*:ti,ab,kw OR 'cross sectional*':ti,ab,kw OR cross?ectional*:ti,ab,kw OR multicent*:ti,ab,kw OR 'multi-cent*':ti,ab,kw OR consecutive*:ti,ab,kw) AND (group:ti,ab,kw OR groups:ti,ab,kw OR subgroup*:ti,ab,kw OR versus:ti,ab,kw OR vs:ti,ab,kw OR compar*:ti,ab,kw OR 'odds ratio*':ab OR 'relative odds':ab OR 'risk ratio*':ab OR 'relative risk*':ab OR 'rate ratio':ab OR aor:ab OR arr:ab OR rrr:ab OR ((('or' OR 'rr') NEAR/6 ci):ab))) |
15725352 |
|
#13 |
#8 AND #9 |
62 |
|
#14 |
#8 AND #10 NOT #13 |
175 |
|
#15 |
#8 AND (#11 OR #12) NOT (#13 OR #14) |
383 |
|
#16 |
#13 OR #14 OR #15 |
620 |
Ovid/Medline
|
# |
Searches |
Results |
|
1 |
exp Rectal Prolapse/ or ((exp Rectum/ or exp Anal Canal/ or rectum.ti,ab,kf. or rectal*.ti,ab,kf. or recti*.ti,ab,kf. or rectosigmoid*.ti,ab,kf. or anus.ti,ab,kf. or anal.ti,ab,kf.) and (exp Prolapse/ or procident*.ti,ab,kf. or prolaps*.ti,ab,kf.)) or ((rect* or anorect* or anus or anal) adj3 (prolaps* or intussuscept* or invaginat* or procident*)).ti,ab,kf. or (((rectal* or rectum or recti* or rectosigmoid* or anus or anal) adj3 fixat*) or proctopex* or rectopex*).ti,ab,kf. or proctoptos*.ti,ab,kf. or archoptos*.ti,ab,kf. |
7165 |
|
2 |
exp Surgical Mesh/ or ((synthetic* or 3d max or bio* or c qur or gore infinit or gore tex dual or kugel or mersuture or surgipro or phs or proceed or polyform or prolene or restorelle or surgipro or tigr or veritas) adj3 mesh*).ti,ab,kf. or ("4ddome" or aigisrx or adhesix or alloderm or allomax or angimesh or cicat or collamend or composix ex patch or composix kugel or composix kugel patch or composix l?p or crurasoft or dermmatrix or dermamatrix or dual mesh or dualmesh or dulex or dynamesh cicat or dynamesh endolap or dynamesh ipoom or dynamesh ipst or dynamesh lichtenstein or dynamesh pp or dynamesh or dynamesh ipom or epidisc or "evolution p3em" or faslata or flex hd or flexhd or flexhd structural or fortagen or fortisan or fortisan fabric or glucamesh or gore tex dualmesh or hi tex or hi tex endo ip or hi tex parp mp or hi tex parp or hi tex parp ph or "hi tex parp ph2" or hi tex parp px or hermesh or "hermesh 0" or "hermesh 10" or "hermesh 3" or "hermesh 4" or "hermesh 5" or "hermesh 6" or "hermesh 7" or "hermesh 8" or "hermesh 9" or hertra or "hertra 1" or "hertra 2" or "hertra 2a" or "hertra 6" or "hertra 6a" or "hertra 7" or "hertra 9" or "hertra 9a" or infinit mesh or intepro lite or intexen or kugel patch or lichtenstein or mersilene polyester fiber suture or motifmesh or mycromesh or mycromesh plus or neoveil or omyra or optilene mesh lp or orthomesh or ovitex prs or parietene or parietene composite or parietene flat sheet or parietene macroporous or parietex progrip or parietex composite or pelvicol or pelvisoft or pelvitex or perfix or peri strips dry or permacol or physiomesh or polysoft hernia patch or polypropylene hernia system or polysoft mesh or progrip or prolite or "prolene 3d patch" or prolene hernia system or prolene polypropylene hernia system or prolene soft or prolene mesh or prolite ultra or restorelle or restorelle a or restorelle directfix or restorelle l or sepramesh or sepramesh ip or sepramesh ip composite or soft mesh or softmesh or strattice or surgimesh or surgimesh wn or surgimesh xb or surgipro mesh clear hernia patch or symbotex or telamax or tigr matrix or tephaflex or tiloop bra or timesh light or tissuemend or trelex or trelex natural or tutomesh or tutopatch or ultrapro or ventralex or ventralight or ventralight st or ventrio or ventrio hernia patch or ventrio st or vitamesh or vypro or vypro ii or vyproii or metallic multi purpose surgical mesh or surgical mesh).ti,ab,kf. |
21724 |
|
3 |
(((bioabsorb* or biofiber or bioresorb* or kerecis or biologic* or phasix or biosynthetic*) adj3 mesh*) or bio-a tissue reinforcement prosthesis or collamend fm implant or dynamatrix or dynamatrix plus or enduragen or gore bio-a fistula plug or gore bio-a hernia plug or gore enform or galaflex or galaflex scaffold or galaform 3d or matristem or miromesh or orthowrap or phasix or phasix st or proformix or seamguard or surgisis or surgisis gold or tenomend or trelliform or vivosorb or x-repair or xenmatrix or xenmatrix ab or xenmatrix surgical graft or xenform or reinforced tissue matrix).ti,ab,kf. |
1629 |
|
4 |
2 or 3 |
21938 |
|
5 |
1 and 4 |
576 |
|
6 |
(rect* adj7 prolaps* adj7 mesh*).ti,ab,kf. |
194 |
|
7 |
5 or 6 |
632 |
|
8 |
limit 7 to yr="2010 -Current" |
452 |
|
9 |
8 not (comment/ or editorial/ or letter/) not ((exp animals/ or exp models, animal/) not humans/) |
401 |
|
10 |
exp Meta-Analysis/ or exp "Meta-Analysis as Topic"/ or exp Network Meta-Analysis/ or exp Systematic Review/ or exp "Systematic Reviews as Topic"/ or (networkmeta analy* or networkmetaanaly* or metaanaly* or meta analy* or metanaly* or prisma or prospero or metaanali* or meta anali* or metanali*).ti,ab,kf. or ((systemati* or scoping or umbrella or structured literature) adj3 (review* or overview*)).ti,ab,kf. or ((structured or systemic*) adj3 (review* or overview* or synth*) adj3 literature).ti,ab,kf. or (systemic* adj1 review*).ti,ab,kf. or ((systemati* or literature or database* or data base*) adj10 search*).ti,ab,kf. or ((structured or comprehensive* or systemic*) adj3 search*).ti,ab,kf. or ((literature adj3 (review* or overview*)) and (search* or database* or data base*)).ti,ab,kf. or ((data extraction* or data source*) and (study selection* or studies selection*)).ti,ab,kf. or (search strateg* and selection criteria*).ti,ab,kf. or (data source* and data synth*).ti,ab,kf. or (medline* or pubmed* or pub med* or embase or cochrane*).ti,ab,kf. or cochrane.jw. or ((critical* or rapid*) adj2 (review* or overview* or synth*)).ti. or (((critical* or rapid*) adj3 (review* or overview* or synth*)) and (search* or database* or data base*)).ab. or metasynth*.ti,ab,kf. or meta synth*.ti,ab,kf. |
806332 |
|
11 |
exp clinical trial/ or randomized controlled trial/ or exp clinical trials as topic/ or randomized controlled trials as topic/ or Random Allocation/ or Double-Blind Method/ or Single-Blind Method/ or (clinical trial, phase i or clinical trial, phase ii or clinical trial, phase iii or clinical trial, phase iv or controlled clinical trial or randomized controlled trial or multicenter study or clinical trial).pt. or random*.ti,ab. or (clinic* adj trial*).tw. or ((singl* or doubl* or treb* or tripl*) adj (blind$3 or mask$3)).tw. or Placebos/ or placebo*.tw. |
2831359 |
|
12 |
Epidemiologic studies/ or case control studies/ or exp cohort studies/ or Controlled Before-After Studies/ or Case control.tw. or cohort.tw. or Cohort analy$.tw. or (Follow up adj (study or studies)).tw. or (observational adj (study or studies)).tw. or Longitudinal.tw. or Retrospective*.tw. or prospective*.tw. or consecutive*.tw. or Cross sectional.tw. or Cross-sectional studies/ or historically controlled study/ or interrupted time series analysis/ [Onder exp cohort studies vallen ook longitudinale, prospectieve en retrospectieve studies] |
4933661 |
|
13 |
Case-control Studies/ or clinical trial, phase ii/ or clinical trial, phase iii/ or clinical trial, phase iv/ or comparative study/ or control groups/ or controlled before-after studies/ or controlled clinical trial/ or double-blind method/ or historically controlled study/ or matched-pair analysis/ or single-blind method/ or (((control or controlled) adj6 (study or studies or trial)) or (compar* adj (study or studies)) or ((control or controlled) adj1 active) or "open label*" or ((double or two or three or multi or trial) adj (arm or arms)) or (allocat* adj10 (arm or arms)) or placebo* or "sham-control*" or ((single or double or triple or assessor) adj1 (blind* or masked)) or nonrandom* or "non-random*" or "quasi-experiment*" or "parallel group*" or "factorial trial" or "pretest posttest" or (phase adj5 (study or trial)) or (case* adj6 (matched or control*)) or (match* adj6 (pair or pairs or cohort* or control* or group* or healthy or age or sex or gender or patient* or subject* or participant*)) or (propensity adj6 (scor* or match*))).ti,ab,kf. or (confounding adj6 adjust*).ti,ab. or (versus or vs or compar*).ti. or ((exp cohort studies/ or epidemiologic studies/ or multicenter study/ or observational study/ or seroepidemiologic studies/ or (cohort* or 'follow up' or followup or longitudinal* or prospective* or retrospective* or observational* or multicent* or 'multi-cent*' or consecutive*).ti,ab,kf.) and ((group or groups or subgroup* or versus or vs or compar*).ti,ab,kf. or ('odds ratio*' or 'relative odds' or 'risk ratio*' or 'relative risk*' or aor or arr or rrr).ab. or (("OR" or "RR") adj6 CI).ab.)) |
5882733 |
|
14 |
9 and 10 |
43 |
|
15 |
(9 and 11) not 14 |
51 |
|
16 |
(9 and (12 or 13)) not (14 or 15) |
178 |
|
17 |
14 or 15 or 16 |
272 |