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Published on: September 11, 2021
Mesh Exposure After Laparoscopic Sacrocolpopexy with Concomitant Total Hysterectomy or Uterine Preservation: A
Rusha Yin1, Yiwei Zhang1, Ying Xiao2
1Department of Obstetrics and Gynecology, State Key Laboratory of Common Mechanism Research for Major Diseases, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
Introduction And Hypothesis:
Although the role of uterine preservation during open sacrocolpopexy was well-explored, data regarding laparoscopic sacrocolpopexy (LSC) are controversial. This study was aimed at comparing the risk of mesh exposure between LSC with total hysterectomy and the uterine-preserving approach.
Methods:
This retrospective cohort study included 198 patients who underwent LSC for pelvic organ prolapse. Based on surgical approach, patients were divided into two groups: those with concomitant total hysterectomy (n = 169) and those who underwent uterus-preserving LSC (n = 29). The primary outcome was mesh exposure. A logistic regression model was employed to calculate odd ratios (OR) and 95% confidence interval (CI) while adjusting potential confounding factors. Secondary outcomes included the composite success, anatomical outcomes, and self-reported symptom improvement.
Results:
The median follow-up time of the whole cohort was 32 months. The incidence of mesh exposure was higher in the hysterectomy group compared with the uterine preservation group (27 out of 169, 16.0% vs 1 out of 29, 3.4%, p = 0.13). After controlling confounding factors, concomitant hysterectomy was associated with a nearly tenfold increased risk of mesh exposure (adjusted OR, 9.9; 95% CI, 1.5 to 199.0). There was no statistically significant difference in the composite success endpoint between the two groups (107 out of 131, 81.7% vs 21 out of 25, 84.0%, p = 0.99).
Conclusions:
Concomitant hysterectomy during LSC was associated with increased risk of mesh exposure, and the composite success rates of the two groups were similar.
