Safety of non-absorbable tack fixation in laparoscopic ventral rectopexy for external and high-grade internal rectal prolapse: early outcomes from a single-centre cohort.

Abstract

The optimal method for mesh fixation during laparoscopic ventral rectopexy (LVR) remains debated, particularly regarding its impact on postoperative chronic pelvic pain and infectious complications. This study aimed to evaluate the safety and early outcomes of non-absorbable helical tack fixation in patients undergoing LVR for external rectal prolapse or high-grade internal prolapse Particular attention was paid to the identification and preservation of key neurovascular structures, including the right hypogastric nerve, L5-S1 intervertebral disc, and first sacral nerve. Mesh fixation over the sacral promontory was performed using three 5-mm non-absorbable helical tacks. Perioperative outcomes and postoperative pain recorded at 30 days, and 3 months were reported. Eighty-seven women underwent LVR between June 2023 and February 2025 (mean age 59.2 ± 12.8 years; BMI 23.5 ± 3.4 kg/m²), 38 with additional sacrocolpopexy (SC). Operative time was 116 min (range: 60-190). No intraoperative conversion occurred and one port-site bleeding was the only intraoperative complication observed. Hospital stay was 2 days (range 2-6); the early postoperative course was uneventful in all patients. At 30 days, 8 (9.2%) patients reported mild pain, and 5 (5.2%) moderate pain. At 3 months, 4 patients (4.6%) reported mild pain. No cases of chronic neuropathic pelvic pain, spondylodiscitis, or tack-related complications were observed. No differences were present among LVR and LVR plus SC for all parameters investigated. In this single-centre cohort, non-absorbable helical tack fixation during LVR was associated with favourable early postoperative outcomes and a low incidence of pain and complications when meticulous surgical technique was applied. However, in the absence of a comparator group, these findings should be interpreted as descriptive and limited to early postoperative safety. Prospective studies with long-term follow-up and a control group are warranted to confirm these findings and further optimize patient-centered outcomes.