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Meta-Analysis
. 2015 Jan;125(1):44-55.
doi: 10.1097/AOG.0000000000000570.

Mesh sacrocolpopexy compared with native tissue vaginal repair: a systematic review and meta-analysis

Nazema Y Siddiqui  1 , Cara L Grimes, Elizabeth R Casiano, Husam T Abed, Peter C Jeppson, Cedric K Olivera, Tatiana V Sanses, Adam C Steinberg, Mary M South, Ethan M Balk, Vivian W Sung; Society of Gynecologic Surgeons Systematic Review Group
Affiliations
Meta-Analysis

Mesh sacrocolpopexy compared with native tissue vaginal repair: a systematic review and meta-analysis

Nazema Y Siddiqui et al. Obstet Gynecol. 2015 Jan.

Abstract

Objective: To systematically review outcomes after mesh sacrocolpopexy compared with native tissue vaginal repairs in women with apical prolapse.

Data sources: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov through June 4, 2012.

Methods of study selection: For anatomic and functional analyses, we included studies comparing mesh sacrocolpopexy to native tissue vaginal repairs with at least 6 months follow-up. The primary outcome was anatomic "success" after surgery. Secondary outcomes were reoperation and symptom outcomes. We included large case series and comparative studies with shorter follow-up to increase power for adverse event analyses.

Tabulation, integration, and results: Evidence quality was assessed with the Grades for Recommendation, Assessment, Development and Evaluation system. Meta-analyses were performed when at least three studies reported the same outcome. We included 13 comparative studies for anatomic success, reoperation, and symptom outcomes. Moderate-quality evidence supports improved anatomic outcomes after mesh sacrocolpopexy; very low-quality evidence shows no differences in reoperation between sacrocolpopexy and native tissue vaginal repairs. Evidence was insufficient regarding which procedures result in improved bladder or bowel symptoms. Low-quality evidence showed no differences in postoperative sexual function. Adverse event data were compiled and meta-analyzed from 79 studies. When including larger noncomparative studies, ileus or small bowel obstruction (2.7% compared with 0.2%, P<.01), mesh or suture complications (4.2% compared with 0.4%, P<.01), and thromboembolic phenomena (0.6% compared with 0.1%, P=.03) were more common after mesh sacrocolpopexy compared with native tissue vaginal repairs.

Conclusion: When anatomic durability is a priority, we suggest that mesh sacrocolpopexy may be the preferred surgical option. When minimizing adverse events or reoperation is the priority, there is no strong evidence supporting one approach over the other.

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Figures

Fig. 1
Fig. 1
PRISMA flow diagram depicting study selection process. RCT, randomized controlled trial; AE, adverse event
Fig. 2
Fig. 2
Forest plot depicting meta-analysis results: anatomic success of mesh sacrocolpopexy compared with native tissue vaginal repair, data from randomized trials. Preop, preoperative; OR, odds ratio; CI, confidence interval; RCT, randomized controlled trial; POPQ Ba, extent of anterior wall prolapse based on Pelvic Organ Prolapse Quantification exam; I2, percentage of total variation across studies due to heterogeneity; Phet, P value for statistical heterogeneity.
Fig. 3
Fig. 3
Forest plot depicting anatomic success of mesh sacrocolpopexy compared with native tissue vaginal repair in trials reporting outcomes by vaginal compartment. Preop, preoperative; OR, odds ratio; CI, confidence interval; RCT, randomized controlled trial; POPQ Ba, extent of anterior wall prolapse based on Pelvic Organ Prolapse Quantification exam.
Fig. 4
Fig. 4
Forest plot depicting data from 3 randomized trials and 2 comparative studies showing reoperation after mesh sacrocolpopexy compared with native tissue vaginal repair. OR, odds ratio; CI, confidence interval; RCT, randomized controlled trial.
See this image and copyright information in PMC

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