Risk of Recurrent Prolapse by Extent of Mesh Excision Procedures: A Multicenter Study

Area of Science:

• Urogynecology
• Pelvic reconstructive surgery
• Surgical mesh complications

Background:

• Limited evidence exists to guide surgeons on the extent of mesh resection for mesh complications.
• Pelvic organ prolapse (POP) mesh complications necessitate surgical intervention, but optimal surgical strategy remains unclear.

Purpose of the Study:

• To compare the rates of recurrent prolapse after major versus minor mesh excisional surgical procedures for prolapse mesh complications.

Main Methods:

• A multicenter, retrospective cohort study analyzed 261 patients undergoing surgical treatment for POP mesh complications between 2010 and 2019.
• Excisional procedures were classified as major (total excisions) or minor (partial excisions/revisions).
• Primary outcome was prolapse recurrence at 1 year, evaluated using Kaplan-Meier analysis and Cox regression.

Main Results:

• Major excisions (73 patients) had a higher 1-year prolapse recurrence rate (8.7%) compared to minor excisions (188 patients, 2.9%).
• The hazard ratio for pelvic organ prolapse recurrence was 6.1 for major versus minor excisions after adjusting for mesh implant type.
• Long-term prolapse recurrence rates did not significantly differ between major and minor excision groups (33.8% overall).

Conclusions:

• Major mesh excision for prolapse complications is associated with higher short-term prolapse recurrence compared to minor excisions.
• Long-term outcomes regarding prolapse recurrence are similar regardless of the extent of mesh excision.
• Findings can assist surgeons in managing patient expectations for procedures addressing mesh complications.