Long-term mesh complications and reoperation after laparoscopic mesh sacrohysteropexy: a cross-sectional study

Izett-Kay, Matthew; Aldabeeb, Dana; Kupelian, Anthony; Cartwright, Rufus; Cutner, Alfred; Jackson, Sonia; Price, Natalia; Vashisht, Arvind

doi:10.1007/s00192-020-04396-0

Cited by 18 publications

(11 citation statements)

References 31 publications

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“…There were no mesh exposures in the MeshH group, similar to the largest reported cross-sectional study for mesh hysteropexy [20]. Pelvic pain was reported by 3% in the MeshH group with no requests for mesh removal.…”

Section: Discussionsupporting

confidence: 70%

Laparoscopic and robot-assisted suture versus mesh hysteropexy: a retrospective comparison

et al. 2022

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Introduction and hypothesis Our study was aimed at comparing the outcomes of laparoscopic and robot-assisted laparoscopic suture-based hysteropexy (SutureH) versus sacral hysteropexy using mesh (MeshH) for bothersome uterine prolapse. Our hypothesis is that MeshH is more successful and provides better uterine support than SutureH. Methods A retrospective cohort study of 228 consecutive women who underwent re-suspension of the uterus using uterosacral ligaments (SutureH n=97) or a “U-shaped” mesh from the sacral promontory (MeshH, n=132). Surgery was performed by laparoscopy or robot-assisted laparoscopy. Subjects were assessed at baseline, 1 year, and beyond 1 year. The null hypothesis, that SutureH and MeshH have similar success, was based on a composite outcome (“composite success”), and that they provide the same level of uterine support, was based on POP-Q point C at 1 year. “Composite success” was defined as: POP-Q point C above the hymen; absence of a vaginal bulge; no repeat uterine prolapse surgery or pessary placement. Other outcomes included improvement in symptomology using Patient Global Impression of Improvement, POP-Q point C change and complications. Results Follow-up data were available for 191 out of 228 women. “Composite success” was not significantly different between MeshH and SutureH groups (81.7% vs 84.5%, p=0.616). MeshH provided better elevation of the uterus than SutureH (point C change: −7.38cm vs −6.99cm; p<0.001). Similar symptom improvement and low complications occurred in both groups. Conclusions Laparoscopic and robot-assisted laparoscopic suture hysteropexy and mesh sacral hysteropexy provide women with minimally invasive, durable surgical options for uterine preservation. “Composite success” was similar in the two groups, but MeshH provided better uterine support than SutureH. However, SutureH gives women an effective mesh-free option.

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Section: Discussionsupporting

confidence: 70%

Laparoscopic and robot-assisted suture versus mesh hysteropexy: a retrospective comparison

et al. 2022

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“…Nightingale and Phillips examined 93 of 112 patients over 9 years of age (mean 6 years follow-up) and reported only one mesh complication (bowel obstruction). We did not find any mesh complication yet and hope to publish a long term follow up soon [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Prospective International Multicenter Pelvic Floor Study: Short-Term Follow-Up and Clinical Findings for Combined Pectopexy and Native Tissue Repair

Noé

Schiermeier

Papathemelis

et al. 2021

JCM

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Efforts to use traditional native tissue strategies and reduce the use of meshes have been made in several countries. Combining native tissue repair with sufficient mesh applied apical repair might provide a means of effective treatment. The study group did perform and publish a randomized trial focusing on the combination of traditional native tissue repair with pectopexy or sacrocolpopexy and observed no severe or hitherto unknown risks for patients (Noé G.K. J Endourol 2015;29(2):210–215). The short-term follow-up of this international multicenter study carried out now is presented in this article. Material and Methods: Eleven clinics and 13 surgeons in four European counties participated in the trial. In order to ensure a standardized approach and obtain comparable data, all surgeons were obliged to follow a standardized approach for pectopexy, focusing on the area of fixation and the use of a prefabricated mesh (PVDF PRP 3 × 15 Dynamesh). The mesh was solely used for apical repair. All other clinically relevant defects were treated with native tissue repair. Colposuspension or TVT were used for the treatment of incontinence. Data were collected independently for 14 months on a secured server; 501 surgeries were registered and evaluated. Two hundred and sixty-four patients out of 479 (55.1%) returned for the physical examination and interview after 12–18 months. Main Outcome and Results: The mean duration of follow-up was 15 months. The overall success of apical repair was rated positively by 96.9%, and the satisfaction score was rated positively by 95.5%. A positive general recommendation was expressed by 95.1% of patients. Pelvic pressure was reduced in 95.2%, pain in 98.0%, and urgency in 86.0% of patients. No major complications, mesh exposure, or mesh complication occurred during the follow-up period. Conclusion: In clinical routine, pectopexy and concomitant surgery, mainly using native tissue approaches, resulted in high satisfaction rates and favorable clinical findings. The procedure may also be recommended for use by general urogynecological practitioners with experience in laparoscopy.

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“…The long-term repeat surgery rate was found to be quite low (3.2%) with the laparoscopic smSHP technique. Previous studies of dual-mesh SHP procedures reported repeat surgery rates between 0% to 13.6% in both short-and longterm follow-up studies (Rahmanou et al, 2014;Jefferis et al, 2017;Lone et al, 2018;Izett-Kay et al, 2020). Jefferis et al (2017) reported repeat apical prolapse surgery in 2.8% and repeat anterior repair in 7.1%, at 10-years follow-up.…”

Section: Discussionmentioning

confidence: 93%

Satisfactory medium-long term patient reported outcomes after laparoscopic single-mesh sacrohysteropexy

Dökmeci¹,

Şükür²,

Çetinkaya³

et al. 2022

Facts Views Vis ObGyn

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Background: There is scarce information on the effectiveness of the laparoscopic single mesh sacrohysteropexy (smSHP). Attachment of a single sheet of flat mesh posteriorly to the cervix provides less mesh use and a less invasive distal mesh fixation. Objectives: To assess medium to long-term follow-up results of patients who underwent laparoscopic smSHP utilising a less invasive technique with single sheet flat mesh. Materials and Methods: In the present retrospective cohort study, the data of 71 women who underwent laparoscopic smSHP for apical uterine prolapse with or without colporrhaphy (anterior and/or posterior) at the urogynaecology unit of a university hospital between January 2008 and January 2020 was reviewed. Data was collected on demographics, presenting symptoms, preoperative findings, surgery, and postoperative outcomes. Main Outcome Measures: Medium to long-term patient-reported outcomes. Results: The median age of the study population was 44 years. Median follow-up duration was 5 years (1-12). Symptomatic recurrence over time and repeat surgery rates were 13.1% and 3.1% respectively. Comparison of the pre-operative and medium to long-term evaluation scores of the pelvic floor distress inventory-20 (PFDI-20) and assessment of the patient global impression of improvement (PGI-I) revealed long-standing improvement in pelvic floor dysfunction. Conclusions: Laparoscopic smSHP appears to be successful and safe with low recurrence and complication rates and provides satisfactory patient reported outcomes. What’s new? Medium to long-term patient-reported outcomes based on PFDI-20 and PGI-I surveys are satisfactory following smSHP.

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Long-term mesh complications and reoperation after laparoscopic mesh sacrohysteropexy: a cross-sectional study

Cited by 18 publications

References 31 publications

Laparoscopic and robot-assisted suture versus mesh hysteropexy: a retrospective comparison

Laparoscopic and robot-assisted suture versus mesh hysteropexy: a retrospective comparison

Prospective International Multicenter Pelvic Floor Study: Short-Term Follow-Up and Clinical Findings for Combined Pectopexy and Native Tissue Repair

Satisfactory medium-long term patient reported outcomes after laparoscopic single-mesh sacrohysteropexy

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