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. 2020 Dec;31(12):2595-2602.
doi: 10.1007/s00192-020-04396-0. Epub 2020 Jul 3.

Long-term mesh complications and reoperation after laparoscopic mesh sacrohysteropexy: a cross-sectional study

Matthew L Izett-Kay  1   2 , Dana Aldabeeb  3 , Anthony S Kupelian  4 , Rufus Cartwright  5 , Alfred S Cutner  4 , Simon Jackson  5 , Natalia Price  5 , Arvind Vashisht  4   3
Affiliations

Long-term mesh complications and reoperation after laparoscopic mesh sacrohysteropexy: a cross-sectional study

Matthew L Izett-Kay et al. Int Urogynecol J. 2020 Dec.

Abstract

Introduction and hypothesis: The paucity of long-term safety and efficacy data to support laparoscopic mesh sacrohysteropexy is noteworthy given concerns about the use of polypropylene mesh in pelvic floor surgery. This study is aimed at determining the incidence of mesh-associated complications and reoperation following this procedure.

Methods: This was a cross-sectional postal questionnaire study of women who underwent laparoscopic mesh sacrohysteropexy between 2010 and 2018. Potential participants were identified from surgical databases of five surgeons at two tertiary urogynaecology centres in the UK. The primary outcome was patient-reported mesh complication requiring removal of hysteropexy mesh. Secondary outcomes included other mesh-associated complications, reoperation rates and Patient Global Impression of Improvement (PGI-I) in prolapse symptoms. Descriptive statistics and Kaplan-Meier survival analyses were used.

Results: Of 1,766 eligible participants, 1,121 women responded (response proportion 63.5%), at a median follow-up of 46 months. The incidence of mesh complications requiring removal of hysteropexy mesh was 0.4% (4 out of 1,121). The rate of chronic pain service use was 1.8%, and newly diagnosed systemic autoimmune disorders was 5.8%. The rate of reoperation for apical prolapse was 3.7%, and for any form of pelvic organ prolapse it was 13.6%. For PGI-I, 81.4% of patients were "much better" or "very much better".

Conclusions: Laparoscopic mesh sacrohysteropexy has a low incidence of reoperation for mesh complications and apical prolapse, and a high rate of patient-reported improvement in prolapse symptoms. With appropriate clinical governance measures, the procedure offers an alternative to vaginal hysterectomy with apical suspension. However, long-term comparative studies are still required.

Keywords: Laparoscopy; Pelvic organ prolapse; Reoperation; Surgical mesh; Uterine prolapse.

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Conflict of interest statement

Matthew Izett-Kay: none; Dana Aldabeeb: none; Anthony Kupelian: honorarium from Olympus; Rufus Cartwright: none; Alfred Cutner: honoraria from Olympus, Stryker and consultancy to Fannin and Coloplast; Simon Jackson: none; Natalia Price: none; Arvind Vashisht: honoraria from Olympus and BARD Medical.

Figures

Fig. 1
Fig. 1
Flow chart of participant recruitment
Fig. 2
Fig. 2
Length of patient follow-up
Fig. 3
Fig. 3
Kaplan–Meier survival analysis with mesh removal surgery as the failure variable
See this image and copyright information in PMC

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