Mesh complications and failure rates after transvaginal mesh repair compared with abdominal or laparoscopic sacrocolpopexy and to native tissue repair in treating apical prolapse

Dandolu, Vani; Akiyama, Miho; Allenback, Gayle; Pathak, Prathamesh

doi:10.1007/s00192-016-3108-3

Cited by 36 publications

(31 citation statements)

References 34 publications

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“…Most studies were of a retrospective design (73.8%). The literature on LSC and RSC shows erosion rates between 0 and 13.3% (range of number of patients included: 12-4,552; range of follow-up 12-72 months) [3,5,. The articles that were included differed in their methods and inclusion criteria.…”

Section: Overview Of Literaturementioning

confidence: 99%

“…This is in line with the mesh erosion rate found in our study. Dandolu et al [3] described a large retrospective cohort of patients (N = 4,552, follow-up ≥2 years) with an apical prolapse who underwent LSC. Mesh removal or revision occurred in 52 patients (1.7%).…”

Section: Overview Of Literaturementioning

confidence: 99%

“…The FDA warnings were underlined by a systematic review reporting an incidence of mesh erosion of 10.3% (range 0-29.7%, n = 11.785) following transvaginal pelvic organ prolapse repair in the first postoperative year [2]. Recent literature on transvaginal repair has confirmed this high incidence [3]. Transabdominal approaches for pelvic reconstructive surgery are associated with a much lower incidence of mesh erosion [1,4].…”

Section: Introductionmentioning

confidence: 99%

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Long-term mesh erosion rate following abdominal robotic reconstructive pelvic floor surgery: a prospective study and overview of the literature

et al. 2019

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Introduction and hypothesis The use of synthetic mesh in transvaginal pelvic floor surgery has been subject to debate internationally.Although mesh erosion appears to be less associated with an abdominal approach, the long-term outcome has not been studied intensively. This study was set up to determine the long-term mesh erosion rate following abdominal pelvic reconstructive surgery. Methods A prospective, observational cohort study was conducted in a tertiary care setting. All consecutive female patients who underwent robot-assisted laparoscopic sacrocolpopexy and sacrocolporectopexy in 2011 and 2012 were included. Primary outcome was mesh erosion. Preoperative and postoperative evaluation (6 weeks, 1 year, 5 years) with a clinical examination and questionnaire regarding pelvic floor symptoms was performed. Mesh-related complications were assessed using a transparent vaginal speculum, proctoscopy, and digital vaginal and rectal examination. Kaplan-Meier estimates were calculated for mesh erosion. A review of the literature on mesh exposure after minimally invasive sacrocolpopexy was performed (≥12 months' follow-up).Results Ninety-six of the 130 patients included (73.8%) were clinically examined. Median follow-up time was 48.1 months (range 36.0-62.1). Three mesh erosions were diagnosed (3.1%; Kaplan-Meier 4.9%, 95% confidence interval 0-11.0): one bladder erosion for which mesh resection and an omental patch interposition were performed, and two asymptomatic vaginal erosions (at 42.7 and 42.3 months) treated with estrogen cream in one. Additionally, 22 patients responded solely by questionnaire and/or telephone; none reported mesh-related complaints. The literature, mostly based on retrospective studies, described a median mesh erosion rate of 1.9% (range 0-13.3%). Conclusions The long-term rate of mesh erosion following an abdominally placed synthetic graft is low.

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Section: Overview Of Literaturementioning

confidence: 99%

Section: Overview Of Literaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-term mesh erosion rate following abdominal robotic reconstructive pelvic floor surgery: a prospective study and overview of the literature

et al. 2019

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“…Therefore, native tissue repair and abdominal approach repair are expected to gain increasing attention for POP management because of the expected decreasing trend of TVM use. For apical prolapse, laparoscopic approaches, such as LLMS, are minimally invasive and have a lower reoperation rate than native tissue repair 9 .…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Long Mesh Surgery with Augmented Round Ligaments: A Novel Uterine Preservation Procedure For Apical Pelvic Organ Prolapse

Long

Wang

Lin

et al. 2020

Sci Rep

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We aim to assess the surgical outcomes of our novel hysteropexy procedure, laparoscopic long mesh surgery (LLMS) with augmented round ligaments. Twenty-five consecutive women with stage II or greater main uterine prolapse defined by the POP quantification staging system were referred for LLMS. Long mesh is a synthetic T-shaped mesh, with the body fixed at the uterine cervix and the two arms fixed along the bilateral round ligaments. The clinical evaluations performed before and 6 months after surgery included pelvic examinations, urodynamic studies, and questionnaires for urinary and sexual symptoms. After a follow-up time of 12 to 24 months, the anatomical reduction rate was 92% (23/25) for the apical compartment. The average operative time was 65.4 ± 28.8 minutes. No major complications were recognized during LLMS. the lower urinary tract symptoms and scores on the questionnaires improved significantly after the surgery, except urgency urinary incontinence and nocturia. Neither voiding nor storage dysfunction was observed after the operations. All of the domains and total Female Sexual Function Index (FSFI) scores of the 15 sexually active women did not differ significantly after LLMS. The results of our study suggest that LLMS is an effective, safe, and timesaving hysteropexy surgery for the treatment of apical prolapse.Pelvic organ prolapse (POP) refers to the downward displacement of pelvic organs 1 . The lifetime risk of surgery for POP in the general female population is 19% 1 . Uterine prolapse, defined by insufficient apical support, is an important issue in the POP field. An increasing number of women with POP choose not to have a hysterectomy for reasons of personal identity, perceived body image, or childbearing potential 2,3 .We started to perform laparoscopic organopexy with non-mesh genital (LONG) suspension in 2014, as an innovative method for treating uterine prolapse in women who wish to preserve their uteri 4 . The LONG procedure has demonstrated promising preliminary results with a cohort of 40 women and a follow-up period of 12-30 months. The anatomical success rate was 85% with no concerning complications reported 4 .Despite the favorable outcome, some skepticism has been raised regarding the durability of suspension power based solely on the adhesion between the transverse fascia beneath the rectus abdominis muscle and the uterus. Other concerns include the long-term effects of the untreated anterior or posterior compartment and the impacts on subsequent hysterectomy, if needed. Studies with longer follow-up durations are ongoing in order to answer these questions. In addition, we have advanced the search for new solutions with our laparoscopic long mesh surgery (LLMS) with augmented round ligaments.Although sacrocolpopexy has been considered the gold-standard procedure for the treatment of apical prolapse, the long operation time and steep learning curve have restricted its popularity 4,5 . Additionally, most of the data have been related to post-hysterectomy prolapse 5 . Transvaginal mesh...

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“…It is suggested that this approach can reduce mesh PPP to a level no greater than after native tissue repair. 5 The prevalence of PPP after retropubic slings is low, so low that it can't be discovered among existing comparative trials that include robust quality of life scoring. Perhaps larger multicentre studies are needed or else these women don't enrol in trials, 6 but they exist, as the large numbers involved in the Shine class action demonstrate.…”

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confidence: 99%

Transvaginal mesh: Let's not repeat the mistakes of the past

Manning¹

2017

Aust NZ J Obst Gynaeco

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Transvaginal mesh: Let's not repeat the mistakes of the past Dear Editor, Patient factors have relevance to chronic mesh morbidity but may have been neglected. At the Food and Drug Administration Medical Device Advisory Committee 2014, 1 Ethicon was asked if: any members of the consortium conducted studies to try to identify which women.… what characteristics individuals may have when they have a more aggressive inflammatory response to the mesh materials? And if so,…what are the results that you've been able to identify? I think it has a lot of clinical relevance for the future because if that could be identified, then potentially there could be screening tests that would be done ahead of time on an individual to find out who is at greater risk for this exaggerated inflammatory response, and those individuals might use then different materials or different approaches to treat their clinical problems. This point was also made by the International Urogynecological Association graft roundtable. 2Ethically supervised randomised trials allow us to quantify the comparative morbidity of lighter coated meshes 3 which might reduce the chronic inflammatory, oxidative response associated with persistent postsurgical pain (PPP). 4 However, there will still be a significant percentage of women who will develop extremely severe, irreversible PPP, even if no mesh is used.We have learnt informally to select patients for mesh procedures on the basis of a range of characteristics which are not included in our randomised trials. It is suggested that this approach can reduce mesh PPP to a level no greater than after native tissue repair. 5The prevalence of PPP after retropubic slings is low, so low that it can't be discovered among existing comparative trials that include robust quality of life scoring. Perhaps larger multicentre studies are needed or else these women don't enrol in trials, 6 but they exist, as the large numbers involved in the Shine class action demonstrate. Even if we can modify mesh to reduce PPP to a 1% additional prevalence, is that acceptable when we are treating such a common yet painless quality of life condition?Future trials might not provide the answers unless we can incorporate predictive factors. Mesh hernia surgeons have created good predictive models that anticipate and thus could prevent PPP morbidity. 7,8 Using a combination of clinical and genetic markers, they demonstrate that the development of pain after groin hernia repair is influenced by both surgical (nerve damage, inflammation, mechanical irritation by the mesh) but also by individual factors (genetics, sensory, psychosocial). Their finding that preoperative pain at the surgical site correlates with persistent postsurgical pain chimes with our anecdotal observation that a painful pessary will predict persistent postsurgical mesh pain. That preoperative sensory thresholds remained unchanged implies preoperative neuroplastic change not necessarily nerve damage. Patients blame nerve damage but we don't include quantitative sensory testing to ...

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Mesh complications and failure rates after transvaginal mesh repair compared with abdominal or laparoscopic sacrocolpopexy and to native tissue repair in treating apical prolapse

Cited by 36 publications

References 34 publications

Long-term mesh erosion rate following abdominal robotic reconstructive pelvic floor surgery: a prospective study and overview of the literature

Long-term mesh erosion rate following abdominal robotic reconstructive pelvic floor surgery: a prospective study and overview of the literature

Laparoscopic Long Mesh Surgery with Augmented Round Ligaments: A Novel Uterine Preservation Procedure For Apical Pelvic Organ Prolapse

Transvaginal mesh: Let's not repeat the mistakes of the past

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