Mesh-related complications from reconstructive surgery for pelvic organ prolapse in Chinese patients in Hong Kong

Wan, Osanna Y K; Chan, Symphorosa Shing Chee; Cheung, Ray C. C.; Chung, Tony K.H.

doi:10.12809/hkmj177173

Cited by 9 publications

(20 citation statements)

References 25 publications

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“…Very‐low‐quality evidence in both RCT and NRSI studies suggests that women who underwent SC suffered a lower rate of mesh complications than women who underwent TVM surgery over a 1‐year period; however, no significant differences were found during the 1‐year follow up. In the RCT group, 18–22 the pooled odds ratio was 0.42 (95% CI 0.18–0.98; I 2 = 0%; P = 0.05), and eight NRSIs with a follow‐up duration of >1 year 23–25,28,31,32,37,38 yielded a pooled odds ratio of 0.38 (95% CI 0.34–0.43; I 2 = 0%; P < 0.01). Three other NRSIs 26,33,36 with follow‐up durations of <1 year presented no significant differences in the occurrence of complications, with a pooled odds ratio of 0.77 (95% CI 0.25–2.33; I 2 = 0%; P = 0.84) (Figure 3A).…”

Section: Resultsmentioning

confidence: 99%

“…There were 20 eligible studies, including four RCTs [18][19][20][21][22] (there were two articles 20,21 about one RCT), four prospective studies [23][24][25][26] and 12 restrospective studies, [27][28][29][30][31][32][33][34][35][36][37][38] identified from the MEDLINE, EMBASE, Cochrane Library and clinicaltrials.gov databases. A PRISMA flow diagram depicting the study selection process is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…There were four RCTs 18,19,22 and six NRSI6 [23][24][25]31,33,37 that reported results regarding subjective success and a followup duration of at least 1 year ( Figure 2D). Considering the very-low-quality evidence, there is probably no difference in the subjective success rate between SC and TVM.…”

Section: Subjective Successmentioning

confidence: 99%

“…Regarding estimated blood loss (see Supplementary material, Figure S2C), five NRSIs 24,31,[36][37][38] favoured lower blood loss with SC than with TVM surgery; the pooled mean difference was À60.37 (95% CI À76.01 to À44.72; I 2 = 30%; P < 0.01). For the occurrence of bladder injury (see Supplementary material, Figure S2D), four RCTs [18][19][20][21][22] and 12 NRSIs 23,25,26,28,29,[31][32][33][35][36][37][38] reported pooled odds ratios of 0.68 (95% CI 0.21-2.23; I 2 = 0%; P = 0.52) and 0.98 (95% CI 0.52-1.88; I 2 = 0%; P = 0.96), respectively. The pooled odds ratios for bowel injury rates (see Supplementary material, Figure S2E) in three RCTs [19][20][21][22] and nine NRSIs 23,25,26,29,32,33,35,36,38 were 1.63 (95% CI 0.20-13.39; I 2 = 0%; P = 0.65) and 1.28 (95% CI 0.44-3.71; I 2 = 0%; P = 0.68), respectively.…”

Section: Perioperative Complicationsmentioning

confidence: 99%

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Sacrocolpopexy compared with transvaginal mesh surgery: a systematic review and meta‐analysis

Zhang

Sun

Yang

et al. 2020

BJOG

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Background The use of mesh is controversial in the treatment of female pelvic organ prolapse. Objectives To systematically review the outcomes of sacrocolpopexy compared with transvaginal mesh surgery and to provide evidence-based suggestions. Search strategy The MEDLINE, EMBASE, Cochrane Library and clinicaltrials.gov databases were searched on 21 November 2018. Selection criteria Randomised controlled trials and prospective and retrospective cohort studies were included. Data collection and analysis Data were extracted by one reviewer and examined by a second reviewer for accuracy. Odds ratios and 95% CI were calculated using random-effects models. Main results Twenty comparative studies were included. The metaanalysis was performed with subgroups. The summary odds ratios of the randomised controlled group were 1.84 (95% CI 0.79-4.29, I 2 = 75%) for anatomical success, 1.41 (95% CI 0.47-4.24, I 2 = 38%) for subjective success, 0.42 (95% CI 0.18-0.98, I 2 = 0%) for mesh complications, 0.61 (95% CI 0.20-1.91, I 2 = 0%) for prolapse reoperation and 0.44 (95% CI 0.23-0.88, I 2 = 0%) for de novo dyspareunia. The mean differences were 0.77 (95% CI 0.31-1.23, I 2 = 66%) for total vaginal length and À1.28 (95% CI À2.00 to À0.55, I 2 = 66%) for point C after surgery. Conclusions Very-low-quality evidence indicated that the anatomical and subjective success rates of sacrocolpopexy were similar to those of transvaginal mesh surgery; sacrocolpopexy might be more beneficial than transvaginal mesh surgery in terms of mesh-related complication rates, prolapse recurrence and de novo dyspareunia. However, additional high-quality randomised trials with long-term follow-up durations are needed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Subjective Successmentioning

confidence: 99%

Section: Perioperative Complicationsmentioning

confidence: 99%

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Sacrocolpopexy compared with transvaginal mesh surgery: a systematic review and meta‐analysis

Zhang

Sun

Yang

et al. 2020

BJOG

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“…The literature suggests a high recurrence rate with VH-PFR-M (15%) and VH-PFR-SSF (33%) [1]. Owing to recent U.S. Food and Drug Administration warnings about mesh-related complications, it is important to explore other techniques that would reduce both recurrence rate and complication rate [2].…”

Section: Introductionmentioning

confidence: 99%

Is performing sacrospinous fixation with vaginal hysterectomy and McCall’s culdoplasty for advanced uterovaginal prolapse preferable over McCall’s culdoplasty alone?

Rajan

Varghese

Roy

et al. 2019

J Obstet Gynecol India

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Purpose of study Advanced uterovaginal prolapse can significantly affect the quality of life in women and usually requires surgical management. McCall's culdoplasty (M) or sacrospinous fixation (SSF) are done at the time of vaginal hysterectomy with pelvic floor repair (VHPFR) to reduce recurrence, but recurrence rates of 15% and 33% have been reported with these procedures respectively. We hypothesize that combining VH-PFR with both McCall's culdoplasty and sacrospinous fixation (VH-PFR-M-SSF) may decrease recurrence rates compared to VH-PFR-M without significantly affecting other perioperative outcomes. Methods All patients with advanced uterovaginal prolapse and willing for VH-PFR at our institute from January 2015 to March 2018 were included after informed consent, except for medically unfit women and those preferring alternative management. We conducted a case control study comparing VH-PFR-M and VH-PFR-M-SSF with a follow-up period of 24 months. Qualitative and quantitative data were statistically analysed and Odds ratio and 95% Confidence interval was calculated. Kaplan Meier Curve was drawn and Log Rank test was used to compare recurrence. Results Out of 174 patients who underwent surgery in the study period, 131 patients (75.28%) underwent VH-PFR-M and 43 patients (24.71%) underwent VH-PFR-M-SSF. Both groups were comparable for age, body mass index, parity, postmenopausal status, comorbidities and aggravating factors. Patients with higher stage of prolapse were more in group 2 (p < 0.001). There were no intraoperative complications or postoperative surgical interventions in either group. The duration of surgery was not significantly different. Change in haematocrit was more in group 2 but no patient required blood transfusion. There was no statistically significant difference in recurrence rates between the 2 groups. Conclusion The procedure (VH PFR M-SSF) is safe and affordable with good results in Stage 3 with advanced bulge and stage 4 prolapse.

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Women with advanced pelvic organ prolapse and levator ani muscle avulsion would significantly benefit from mesh repair surgery

Wong

Cheung

Lee

et al. 2021

Ultrasound in Obstet & Gyne

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What are the novel findings of this work? In women with Stage-III or Stage-IV pelvic organ prolapse (POP), mesh repair surgery, compared with native-tissue repair, reduces the risk of subjective recurrence (odds ratio (OR), 0.20) and objective recurrence (OR, 0.16) of prolapse. Levator ani muscle (LAM) avulsion increases the risk of objective recurrence (OR, 1.8). Mesh repair is associated with a 6-fold decrease in the risk of objective POP recurrence in women with POP Stage III or IV, and a 4-fold reduction in women who also have LAM avulsion. What are the clinical implications of this work? Mesh repair surgery should be a treatment option for women with advanced POP and LAM avulsion, as its benefits outweigh the risks of mesh-related complications.

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Mesh-related complications from reconstructive surgery for pelvic organ prolapse in Chinese patients in Hong Kong

Abstract: The rates of mesh exposure and re-operation were consistent with those reported in the literature, suggesting no significant differences in outcome between Chinese and Western patients for this type of surgery.

Cited by 9 publications

References 25 publications

Sacrocolpopexy compared with transvaginal mesh surgery: a systematic review and meta‐analysis

Sacrocolpopexy compared with transvaginal mesh surgery: a systematic review and meta‐analysis

Is performing sacrospinous fixation with vaginal hysterectomy and McCall’s culdoplasty for advanced uterovaginal prolapse preferable over McCall’s culdoplasty alone?

Women with advanced pelvic organ prolapse and levator ani muscle avulsion would significantly benefit from mesh repair surgery

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