Anterior mesh length as a predictor of sacrocolpopexy success

Abstract

To evaluate the effect of anterior mesh length as a predictor of success or failure after sacrocolpopexy using a Y-shaped synthetic mesh. A retrospective cohort study was performed of women who underwent sacrocolpopexy at a single institution in 2018 and 2019. All patients whose operative documentation reported the final anterior length of the Y-shaped synthetic mesh and who had surgical outcome data reported postoperatively were included. Anterior mesh length was analyzed as a proportion of each patient’s preoperative total vaginal length (TVL). Objective outcomes were reported and analyzed using the Pelvic Organ Prolapse Quantification (POP-Q) System. Objective failure was defined as any POP-Q point meeting or exceeding 0 (representing prolapse extending to or beyond the hymenal ring), or Stage 2 and greater if quantitative data were not reported. Subjective failure was defined as patient complaint of persistent or worsening vaginal bulge since surgery. Descriptive characteristics were compared between patients with objective or subjective failure versus those who did not. A total of 88 patients were identified to have undergone sacrocolpopexy during the specified timeframe and met our study’s inclusion criteria. There were no significant differences in demographic or preoperative characteristics between patients who experienced objective failure and those who did not. Patients who reported subjective failure were statistically more likely to have been pregnant fewer times, had a history of hysterectomy prior to their sacrocolpopexy, or underwent hysterectomy at the time of their sacrocolpopexy. The overall objective and subjective failure rates in our sample were 19.3% and 9.1% respectively, with no statistically significant differences in the primary surgeon or route (robotic-assisted versus laparoscopic) for either outcome. There was a statistically significant difference in objective failure rates depending on the percentage of TVL reached with the anterior vaginal mesh; the lowest objective failure rate (7.1%) was noted when the final anterior mesh length was within 71% to 80% of preoperative TVL, while the highest objective failure rate (40%) was demonstrated when the final anterior mesh length exceeded 80% of preoperative TVL. These findings were not corroborated nor statistically significant upon comparing patients reporting subjective failure and those who did not. This data suggest that the final length of the anterior portion of the Y-shaped synthetic mesh commonly used for sacrocolpopexy may have an effect on objective failure postoperatively. However, longer final anterior mesh lengths do not necessarily correlate with greater objective success which may be related to technical and other confounding factors. Future research with larger sample sizes may further elucidate these factors and aid surgeons in the development of best practice guidelines.View Large Image Figure ViewerDownload Hi-res image Download (PPT)