Abstract
Introduction and hypothesisThe use of synthetic mesh in transvaginal pelvic floor surgery has been subject to debate internationally. Although mesh erosion appears to be less associated with an abdominal approach, the long-term outcome has not been studied intensively. This study was set up to determine the long-term mesh erosion rate following abdominal pelvic reconstructive surgery.MethodsA prospective, observational cohort study was conducted in a tertiary care setting. All consecutive female patients who underwent robot-assisted laparoscopic sacrocolpopexy and sacrocolporectopexy in 2011 and 2012 were included. Primary outcome was mesh erosion. Preoperative and postoperative evaluation (6 weeks, 1 year, 5 years) with a clinical examination and questionnaire regarding pelvic floor symptoms was performed. Mesh-related complications were assessed using a transparent vaginal speculum, proctoscopy, and digital vaginal and rectal examination. Kaplan–Meier estimates were calculated for mesh erosion. A review of the literature on mesh exposure after minimally invasive sacrocolpopexy was performed (≥12 months’ follow-up).ResultsNinety-six of the 130 patients included (73.8%) were clinically examined. Median follow-up time was 48.1 months (range 36.0–62.1). Three mesh erosions were diagnosed (3.1%; Kaplan–Meier 4.9%, 95% confidence interval 0–11.0): one bladder erosion for which mesh resection and an omental patch interposition were performed, and two asymptomatic vaginal erosions (at 42.7 and 42.3 months) treated with estrogen cream in one. Additionally, 22 patients responded solely by questionnaire and/or telephone; none reported mesh-related complaints. The literature, mostly based on retrospective studies, described a median mesh erosion rate of 1.9% (range 0–13.3%).ConclusionsThe long-term rate of mesh erosion following an abdominally placed synthetic graft is low.
Highlights
Introduction and hypothesisThe use of synthetic mesh in transvaginal pelvic floor surgery has been subject to debate internationally
The two abdominal procedures combined have been described and are being used as a treatment for combined pathology [7, 8]. It is against this backdrop that we designed a study to evaluate the long-term mesh erosion rate following robotassisted laparoscopic sacrocolpopexy (RSC) and robotassisted laparoscopic sacrocolporectopexy (RSCR)
Synthetic meshes have been used in pelvic reconstructive surgery to reinforce weak or defective supportive tissue since 1959 [80]
Summary
In 2008 and 2011, the US Food and Drug Administration (FDA) warned about the high rate of meshrelated complications following transvaginal pelvic organ prolapse repair [1]. The FDA warnings were underlined by a systematic review reporting an incidence of mesh erosion of 10.3% (range 0–29.7%, n = 11.785) following transvaginal pelvic organ prolapse repair in the first postoperative year [2]. The two abdominal procedures combined have been described and are being used as a treatment for combined pathology [7, 8] It is against this backdrop that we designed a study to evaluate the long-term mesh erosion rate following robotassisted laparoscopic sacrocolpopexy (RSC) and robotassisted laparoscopic sacrocolporectopexy (RSCR). We performed a literature review on mesh erosion after minimally invasive sacrocolpopexy with a minimum follow-up duration of 12 months
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