Removal of Infected Residual Mesh in a Rectopexy Patient through Endo-anal Pull through - an Innovative Approach

*Corresponding Author:Debarshi Jana. ..................................................................................................................... Abstract: Objective: The aim of this study is to reproduce successfully the principle of a pediatric surgical operation in a complicated adult patient. Summary Background Data: Mesh rectopexy is a known operation, infection in mesh is an unknown complication but it happens. Several techniques had been reported in journals. Our challenging case where the residual mesh migrated down and the patient was treated with total proctectomy and endo-anal pull-through procedure. So far literature review suggests this is the first case of this kind. Methods: This patient was operated after reviewing the situation and following the pediatric surgical principle. Results: We have operated the patient successfully and patient has recovered well. Conclusions: Our patient was a unique complicated patient and we had applied pediatric surgical principle successfully. ..................................................................................................................... Introduction:Mesh rectopexy is a standard recommended operation for rectal prolapse and complication like mesh erosion into the rectum is rare but a known complication [1]. Removal of the mesh is a standard treatment in such a scenario. Various methods of mesh removal in this condition had been reported in the literature [2]. Laparoscopic removal or open procedure like colostomy [3] and mesh removal and anterior resection [4] has been reported by various authors. Endo anal pull through was describe by soave for Hirschprung Disease (HD), which is essentially a disease of the lower rectum where innervation is absent [5]. The Principle of the procedure was later used in low rectal cancer successfully [6]. We understood after reviewing the pathology that the mesh is intimately adherent to the rectal wall and is incorporated into the rectal wall. Removal of the mesh would cause injury to the rectal wall and subsequent rectal stricture or fistula formation. As we all know the connective tissue and the inflammatory infiltrate develops around the mesh and tissue is integrated and consolidated [7].We adapted an innovative way to solve the residual mesh erosion through Soave technique by doing distal proctectomy and established the continuity through endo-anal pull through.