Abstract
BackgroundThere are safety concerns regarding the use of mesh in vaginal surgery with a call for long-term follow-up data. This study was designed to evaluate the long-term safety and efficacy of vaginal repairs performed for recurrent cystocele using Perigee (non-absorbable trans-obturator) mesh.MethodsA retrospective consecutive cohort of 48 women who underwent surgery for recurrent prolapse between March 2007 and December 2011 in a single centre was reviewed. Satisfaction was assessed using the patient global impression of improvement (PGI-I). Symptoms were assessed with the pelvic floor distress inventory (PFDI). Women were questioned regarding pain, sexual activity and pelvic floor surgery performed since the original procedure and examined for erosion. Women were compared to 25 controls from a consecutive cohort of repeat anterior colporrhapies.ResultsThe mean length of follow-up was 6.5 years (78 months; range 48–106). Significantly more women in the mesh group reported that they were “much better” or “very much better” (69 vs 40% p = 0.02). The rate of mesh erosion at follow-up was 11.6%. Two women in the mesh group required surgical excision of eroded mesh in the operating room (4%). The reoperation rate for a combination of de novo stress incontinence, recurrent prolapse and mesh exposure was similar in each group (33% mesh vs 32% native tissue).ConclusionsA vaginal mesh repair using a non-absorbable trans-obturator mesh has improved satisfaction compared to an anterior colporrhaphy.
Highlights
There are safety concerns regarding the use of mesh in vaginal surgery with a call for long-term follow-up data
The same technique was used for mesh repairs other than the repair was augmented with placement of non-absorbable mesh under the fascial plication sutures
Twenty-five were interviewed (66%) and one woman had died of unrelated causes
Summary
There are safety concerns regarding the use of mesh in vaginal surgery with a call for long-term follow-up data. This study was designed to evaluate the long-term safety and efficacy of vaginal repairs performed for recurrent cystocele using Perigee (non-absorbable trans-obturator) mesh. Eleven percent of women will have undergone a surgical repair by the age of 80 [3]. There is a significant recurrent prolapse rate after primary native tissue repair [5]. Mesh repairs were introduced to reinforce the native tissues aiming to reduce recurrence rates. A Cochrane review suggested recurrence rates are lower using non absorbable mesh augmented repairs [6]. There are complications unique to mesh repairs and 12% of patient will have a mesh complication and a proportion of these will require further surgical intervention to manage the complication [5, 6]. High rates of pain and dyspareunia have been reported affecting patient satisfaction [7]
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