Retrospective Cohort Study of Mesh-Related Complications of Minimally Invasive Sacrocervicopexy in 603 cases

Minimally invasive sacrocolpopexy (SCP) with concurrent supracervical hysterectomy (SCH) has become the preferred treatment for uterovaginal prolapse over traditional open surgery. However, there is a lack of standardization in surgical materials and techniques, leading to variations in outcomes. This study aims to examine mesh-related complications in women undergoing SCP with concurrent SCH.

A retrospective cohort study was conducted within a large academic hospital system between May 2007 and December 2021. Participants who underwent SCP with concurrent SCH were included. Demographics, perioperative characteristics, and postoperative data were collected. Mesh complications were identified using CPT codes and confirmed by chart review. Parametric and nonparametric tests were used to assess differences in participant and surgical factors, with significance set at p ≤ 0.05.

A total of 603 participants were analyzed with a mean follow-up of 55 months. Most underwent laparoscopic SCP (87%), with 53% performed by minimally invasive gynecologic surgery (MIGS) and 47% performed by urogynecology and reconstructive pelvic surgery (URPS). Mesh exposure occurred in 1.2% of cases and was significantly associated with permanent multifilament braided suture use for vaginal mesh attachment (p < 0.001). All exposures occurred in surgeries performed by MIGS surgeons. No significant associations were found with smoking, menopausal status, estrogen use, primary energy instrumentation, or mesh weight. Notably, no mesh erosions were observed.

Mesh-related complications following SCP with concurrent SCH are rare. Permanent multifilament braided suture was the only factor associated with mesh exposure. Further research is needed to evaluate surgical factors and optimize techniques.