Comparative Retrospective Study of Tension-Free Vaginal Mesh Surgery, Native Tissue Repair, and Laparoscopic Sacrocolpopexy for Pelvic Organ Prolapse Repair

Abstract

Introduction and Hypothesis. Many would argue that sacrocolpopexy is the standard surgical procedure for pelvic organ prolapse (POP), but other surgical techniques were proposed and practically applying to the patients with POP. In this study, we compared postoperative outcomes of three surgical methods for POP repair. Methods. We identified that 308 women who had undergone surgical repair of POP were followed up for at least 6 months. Recurrence rates of POP after tension-free vaginal mesh (TVM) surgery (n � 243), native tissue repair (NTR) (vaginal hysterectomy with colpopexy, anterior and posterior colpoplasty, or circumferential suturing of the levator ani muscles and apical repair by transvaginal sacrospinous ligament fixation (SSLF)) (NTR; n � 31), and laparoscopic sacrocolpopexy after subtotal hysterectomy (LSC; n � 34) were compared. Presence of mesh erosion was also recorded. Results. Patients who underwent LSC were significantly younger (65.32 ± 3.23 years) than those who underwent TVM surgery (69.61 ± 8.31 years). After TVM surgery, the rate of recurrence (over POP-Q stage II) was 6.17% (15/243) and was highest in patients with advanced POP. e recurrence rate in patients who underwent NTR procedure was 3.23% (1/34) and that in patients who underwent LSC was 11.76% (4/11). ere was no statistically significant difference in the recurrence rate between the three types of surgery. ere were 13 cases (5.35%) of mesh erosion after TVM surgery and none after LSC surgery. e risk of mesh erosion was correlated with having had total TVM surgery but not with patient age or POP stage. Repeat procedures were performed in 5 women (2.14%) who underwent TVM surgery and 1 (2.94%) who underwent LSC. No patient underwent repeat surgery after NTR. ere was no statistically significant difference in the reoperation rate between the three types of surgery. Conclusion. Our study suggested that TVM surgery, NTR, and LSC have comparable outcomes as for the postoperative recurrence rate and mesh erosion. However, the outcomes of each technique need to be carefully evaluated over a long period of time.

Postoperative adverse events and re‐treatment among patients who have undergone laparoscopic and robotic sacrocolpopexy for pelvic organ prolapse in Japan

“…The sample size in the current study was larger than that in previous studies from Asian countries 12,15,16 . Two studies from Japan investigated LSC complications and postoperative clinical outcomes; however, their sample sizes were small (34 and 46 patients, respectively) 12,15 .…”

“…The sample size in the current study was larger than that in previous studies from Asian countries. 12,15,16 Two studies from Japan investigated LSC complications and postoperative clinical outcomes; however, their sample sizes were small (34 and 46 patients, respectively). 12,15 Although a retrospective study from Hong Kong assessed the perioperative and postoperative outcomes after LSC and robot-assisted LSC in 2011, the study also comprised a small sample size (36 patients in total).…”

“…12,15,16 Two studies from Japan investigated LSC complications and postoperative clinical outcomes; however, their sample sizes were small (34 and 46 patients, respectively). 12,15 Although a retrospective study from Hong Kong assessed the perioperative and postoperative outcomes after LSC and robot-assisted LSC in 2011, the study also comprised a small sample size (36 patients in total). 16 A previous study using a large sample size from Japan exclusively assessed perioperative and short-term outcomes during hospitalization for tension-free vaginal mesh and LSC in patients with POP.…”

Postoperative complications and unanticipated healthcare encounters following mini-laparotomy vs. laparoscopic/robotic-assisted sacrocolpopexy: a comparative retrospective study

“…To date, SCP is considered the most durable surgery available for treatment of apical prolapse [ 19 , 24 , 25 ]. In recent years minimally invasive techniques such as straight stick and robotic-assisted laparoscopic surgery have emerged as the standard of care when performing SCP with low complication rates, less blood loss, and shorter hospital stay while maintaining high cure rates and low recurrence rates [ 26 ].…”

Transperineal pelvic floor ultrasound for analyzing the outcomes of pelvic floor surgery for the treatment of anterior compartment prolapse: A comparative study of transvaginal mesh and native‐tissue repair

“…The conventional NTR procedure included vaginal hysterectomy, Manchester operation, anterior colporrhaphy, posterior colporrhaphy, and sacrospinous ligament fixation. The conventional TVM procedure, described elsewhere, 7 involves the implantation of a synthetic mesh in areas of vesicovaginal or rectovaginal dissection spaces, including the anterior TVM, posterior TVM, anterior and posterior TVM, and total TVM 8 . In this study, anterior compartment prolapse was treated with an anterior TVM procedure.…”