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Compartment-Specific Outcomes of Single-Mesh and Double-Mesh Reinforcement in Laparoscopic Sacrocolpopexy: A
Hirotaka Sato1, Shota Otsuka1, Kenji Sugita2
1Department of Urology (Sato, Otsuka), Hokusuikai Kinen Hospital, Ibaraki, Japan.
Objective:
To compare long-term anatomical, subjective, and surgical outcomes of single-mesh and double-mesh reinforcement for laparoscopic sacrocolpopexy (LSC) by focusing on compartment-specific failure and reoperation.
Design:
Retrospective cohort study.
Setting:
Single tertiary referral center.
Participants:
Women (n = 897) who underwent LSC-based apical prolapse surgery between 2015 and 2024.
Interventions:
Patients were classified according to whether single-mesh (anterior-only or posterior-only mesh; n = 560) or double-mesh (anterior and posterior mesh; n = 337) reinforcement was performed during the index surgery.
Results:
The primary outcome was time to anatomical failure (AF) in the reinforced compartment (n = 54 patients). Secondary outcomes included AF in nonreinforced compartments, subjective failure (SF), composite failure (CF), reoperation for recurrent prolapse, and mesh-related complications. The AF-free survival rate in the double-mesh group was similar to that in the single-mesh group (92.6% vs. 92.7%; log-rank p = .95). The mesh configuration was not associated with AF in the reinforced compartment (adjusted hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.47-1.49). AF in nonreinforced compartments occurred exclusively in the single-mesh group. Firth's penalized Cox regression demonstrated a substantially increased risk of AF in nonreinforced compartments associated with single-mesh reinforcement (adjusted HR, 38.13; 95% CI, 3.70-86,989.61). Reoperation in nonreinforced compartments was limited to the single-mesh group (adjusted HR, 38.23; 95% CI, 3.78-5269.73). CF and SF were more frequent in the single-mesh group. The single-mesh group had a higher risk of SF (adjusted HR, 4.88; 95% CI, 1.19-20.0). Mesh-related complications were infrequent and comparable between groups.
Conclusion:
Reinforced compartment durability after LSC was similar between groups. Single-mesh reinforcement was associated with higher risks of failure and reoperation, which led to inferior composite and subjective outcomes without increased mesh-related complications.
