Abstract
Introduction and hypothesisThe 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.MethodsThis 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.ResultsOf 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”.ConclusionsLaparoscopic 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.
Highlights
Introduction and hypothesisThe 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
In the UK, the preferred procedure for the treatment of this highly prevalent condition is a vaginal hysterectomy (VH) and apical suspension procedure, with or without concomitant colporrhaphy [2, 3]. This approach is limited by a high risk of recurrent vault prolapse, rates of reoperation for prolapse are between 4.6% and 18% [4, 5]
We report a low incidence of patient-reported mesh complications requiring mesh removal surgery confirmed by case note review, of 0.4% at a median follow-up of nearly 4 years, from a cohort of 1,121 women who underwent laparoscopic mesh sacrohysteropexy
Summary
Introduction and hypothesisThe 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. In the UK, the preferred procedure for the treatment of this highly prevalent condition is a vaginal hysterectomy (VH) and apical suspension procedure, with or without concomitant colporrhaphy [2, 3]. This approach is limited by a high risk of recurrent vault prolapse, rates of reoperation for prolapse are between 4.6% and 18% [4, 5]. A significant proportion of women would prefer uterine preservation if given the option [6] These two factors may explain the growing use of uterine-sparing techniques [7]. Laparoscopic mesh sacrohysteropexy is one such uterinesparing procedure and involves re-suspending the uterus with polypropylene mesh anchored to the sacral promontory
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