Single‑incision mesh vs sacrospinous ligament fixation in posthysterectomy women at a three-year follow-up: a randomized trial

Abstract

Objectives: The primary clinical objective was to prospectively compare the effectiveness of the "single‑incisionMESH" technique versus sacrospinous ligament fixation (ACSSF) in correcting the defect of pelvic organ prolapse(POP) in the anterior and apical compartments, Their effectiveness was assessed at a 1-year/3-year follow-up (FU).

Methods: In the period of 2013-2015, we have randomized 146 women into two groups, namely 73 into ACSSF group and 73 into MESH groupRESULTS: At 1-year/3-year FU, we achieved an effectiveness of 92 %/87 % in the point Ba (≤‒1 cm) in the MESH group (48/52; 40/46) vs 70 %/66 % in the ACSSF group (35/50; 30/45); (p = 0.005/p = 0.021). At 1-year/3-year FU, in the area of point C (≤‒1 cm), we achieved a 94 %/91 % effectiveness in the MESH group (49/52; 42/46) vs 90 %/80 % in the ACSSF group (45/50; 36/45); (p = 0.005/p = 0.192). In the MESH group, we observed a more frequent occurrence of "de novo" SUI (11 % vs 6 %) and a defect in the unoperated (posterior) compartment (18 % vs 8 %); the difference was not statistically significant.

Conclusion: Our study showed that the vaginal synthetic mesh repair of POP did not improve women's outcomes in terms of effectiveness or adverse effects, while the patient satisfaction is the same as compared to that with sacrospinous ligament fixation at a 3‑year FU. In gynecology, there are situations in which the comparison replaces the scientific solution (Tab. 5, Fig. 2, Ref. 50). Text in PDF www.elis.sk Keywords: sacrospinous ligament fixation, quality of life index, synthetic mesh, randomized trial, prolapse.