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Abdominal sacral suspensions: analysis of complications using permanent mesh
Giti Bensinger1, Larry Lind, Martin Lesser
1Department of Obstetrics and Gynecology, North Shore University Hospital, Manhasset, NY, USA.
American Journal of Obstetrics and Gynecology
|December 6, 2005
Summary
Abdominal sacral suspension (ASC) with polypropylene mesh is a safe procedure for vaginal vault prolapse. However, concurrent ASC during total abdominal hysterectomy (TAH) significantly increases mesh erosion risk compared to supracervical hysterectomy (SCH).
Area of Science:
- Urogynecology
- Pelvic reconstructive surgery
- Surgical mesh complications
Background:
- Vaginal vault prolapse is a common condition affecting women's quality of life.
- Abdominal sacral suspension (ASC) using polypropylene mesh is a surgical option for treating pelvic organ prolapse.
- The safety and complication rates of ASC, particularly mesh erosion, require thorough investigation in different surgical contexts.
Purpose of the Study:
- To determine the complication rates associated with abdominal sacral suspension (ASC) using polypropylene mesh.
- To compare mesh erosion rates in women undergoing ASC during supracervical hysterectomy (SCH) versus total abdominal hysterectomy (TAH) versus ASC alone after prior TAH.
Main Methods:
- Retrospective analysis of 121 patients who underwent ASC with polypropylene mesh between March 1997 and July 2004.
- Patients were stratified into three groups: SCH with ASC, TAH with ASC, and ASC alone after prior TAH.
- Chart review for demographics, surgical history, intraoperative, and postoperative findings, including complications.
Main Results:
- Overall mesh erosion rate was 3.3% (4 patients).
- All mesh erosions occurred in the TAH with ASC group (8.2%), indicating a significantly higher risk compared to SCH with ASC.
- No significant differences were found in age, weight, parity, menopausal status, or preoperative prolapse degree between patients with and without erosions.
- Intraoperative (2.5%) and short-term (3.5%-9.6%) and long-term (1.6%-6.3%) complication rates were similar across all groups, except for mesh erosion.
Conclusions:
- Abdominal sacral suspension (ASC) with polypropylene mesh is a safe procedure for vaginal vault prolapse with generally low complication rates.
- Concurrent ASC during total abdominal hysterectomy (TAH) is associated with a significantly higher risk of mesh erosion compared to ASC during supracervical hysterectomy (SCH).
- Further research may be warranted to explore strategies to mitigate erosion risk in patients undergoing concurrent TAH and ASC.