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Long-term mesh complications and reoperation after laparoscopic mesh sacrohysteropexy: a cross-sectional study
Matthew L Izett-Kay1,2, Dana Aldabeeb3, Anthony S Kupelian4
1Urogynaecology and Pelvic Floor Unit, University College London Hospitals, Clinic 2, Lower Ground Floor, EGA Wing, 235 Euston Road, London, NW12BU, UK. m.izett@ucl.ac.uk.
Introduction And Hypothesis:
The 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.
Methods:
This 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.
Results:
Of 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".
Conclusions:
Laparoscopic 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.
Insights
Laparoscopic mesh sacrohysteropexy shows a low rate of mesh complications (0.4%) and reoperations for apical prolapse (3.7%). Most patients reported significant improvement in pelvic organ prolapse symptoms.
Area of Science:
- Urogynaecology
- Minimally invasive surgery
- Pelvic floor reconstructive surgery
Background:
- Laparoscopic mesh sacrohysteropexy is a surgical option for pelvic organ prolapse.
- Limited long-term safety and efficacy data exist for this procedure.
- Concerns regarding polypropylene mesh use in pelvic floor surgery necessitate safety evaluations.
Purpose of the Study:
- To determine the incidence of mesh-associated complications requiring removal.
- To assess reoperation rates following laparoscopic mesh sacrohysteropexy.
- To evaluate patient-reported outcomes and improvement in prolapse symptoms.
Main Methods:
- Cross-sectional postal questionnaire study.
- 1,121 women who underwent laparoscopic mesh sacrohysteropexy between 2010-2018 participated.
- Median follow-up was 46 months; outcomes included mesh complications, reoperations, and Patient Global Impression of Improvement (PGI-I).
Main Results:
- Mesh complications requiring removal occurred in 0.4% of patients.
- Reoperation rates were 3.7% for apical prolapse and 13.6% for any pelvic organ prolapse.
- 81.4% of patients reported being "much better" or "very much better" regarding prolapse symptoms.
Conclusions:
- Laparoscopic mesh sacrohysteropexy demonstrates a low incidence of mesh complications and reoperations for apical prolapse.
- The procedure is associated with high patient-reported improvement in prolapse symptoms.
- It offers an alternative to vaginal hysterectomy with apical suspension, pending further comparative studies.
