Endometriosis Is Not Associated With Mesh Excision in a Case-control Study

Like polypropylene mesh complications, endometriosis is characterized by inflammation and pain. Chronic pelvic pain is overrepresented in patients with mesh complications. It is unknown whether endometriosis specifically is a risk factor for mesh excision.

The objective of this study was to evaluate whether patients undergoing mesh excision have a higher rate of endometriosis diagnosis than those who heal well after mesh implantation.

We conducted an unmatched case-control study on patients undergoing mesh excision (n=179). Our control group consisted of patients with implanted mesh without complications (n=65). Endometriosis diagnosis was abstracted from charts using a comprehensive definition and pathology reports, where available. Logistic regression was used to evaluate the association between endometriosis diagnosis and mesh excision while controlling for patient factors.

Patients underwent excision primarily for pain (29%), mesh exposure (67%), or infection (3%). Patients undergoing excision were younger ( P <0.001), had a higher body mass index ( P =0.002), and were current or former smokers ( P <0.001). Although these patients did have a higher rate of endometriosis on univariate analysis (18.4% vs. 7.7%, 0.046), this was no longer significant when controlling for demographic and clinical factors (adjusted odds ratio [aOR]=2.32; 95% CI: 0.70, 7.70). A 5-year decrease in age (aOR=1.35; 95% CI: 1.16, 1.57), current or former smoker status (aOR=2.75; 95% CI: 1.36, 5.57), body mass index (aOR=1.09; 95% CI: 1.02, 1.18), and duration of implantation (aOR=1.18; 95% CI: 1.07, 1.30) were independently associated with mesh excision.

Endometriosis diagnosis was not a significant predictor of mesh excision when controlling for other established risk factors.