Polypropylene Mesh Predicts Mesh/Suture Exposure After Sacrocolpopexy Independent of Known Risk Factors: A Retrospective Case-Control Study

Durst, Paula J.; Heit, Michael

doi:10.1097/spv.0000000000000452

Cited by 8 publications

(9 citation statements)

References 22 publications

(19 reference statements)

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“…Nowadays, it is common practice to use resorbable sutures, which might lead to fewer suture exposures [ 28 ]. There were no other surgery-related risk factors in our study population, such as concomitant hysterectomy [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…More is known about patient-related and surgery-related risk factors for developing mesh exposure after sacrocolpopexy. Patients should be counseled accordingly and gynecologists should consider adjusting their technique to minimize the risk of mesh-related complications [ 29 , 33 ]. LSC is a difficult procedure with a long learning curve; therefore, we believe this surgery should be performed by experienced surgeons and centralized care is preferable when the volumes are low.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic sacrocolpopexy versus abdominal sacrocolpopexy for vaginal vault prolapse: long-term follow-up of a randomized controlled trial

et al. 2022

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Introduction and hypothesis The objective of this study was to evaluate long-term outcomes of laparoscopic sacrocolpopexy (LSC) versus abdominal sacrocolpopexy (ASC) for vaginal vault prolapse (VVP). Methods Long-term follow-up of a multicenter randomized controlled trial (SALTO trial). A total of 74 women were randomly assigned to LSC ( n =37) or ASC ( n =37). Primary outcome was disease-specific quality of life, measured with validated questionnaires. Secondary outcomes included anatomical outcome, composite outcome of success, complications, and retreatment. Results We analyzed 22 patients in the LSC group and 19 patients in the ASC group for long-term follow-up, with a median follow-up of 109 months (9.1 years). Disease-specific quality of life did not differ after long-term follow-up with median scores of 0.0 (LSC: IQR 0–17; ASC: IQR 0–0) on the “genital prolapse” domain of the Urogenital Distress Inventory in both groups ( p = 0.175). Anatomical outcomes were the same for both groups on all points of the POP-Q. The composite outcome of success for the apical compartment is 78.6% ( n = 11) in the LSC group and 84.6% ( n = 11) in the ASC group ( p = 0.686). Mesh exposures occurred in 2 patients (12.5%) in the LSC group and 1 patient (7.7%) in the ASC group. There were 5 surgical reinterventions in both groups (LSC: 22.7%; ASC: 26.3%, p = 0.729). Conclusions At long-term follow-up no substantial differences in quality of life, anatomical results, complications, or reinterventions between LSC and ASC were observed. Therefore, the laparoscopic approach is preferable, considering the short-term advantages. Trial registration Dutch Trial Register NTR6330, 18 January 2017, https://www.trialregister.nl/trial/5964

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Laparoscopic sacrocolpopexy versus abdominal sacrocolpopexy for vaginal vault prolapse: long-term follow-up of a randomized controlled trial

et al. 2022

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“…After implantation, Gynemesh PS can induce stronger foreign body inflammatory responses than lighter type 1 polypropylene mesh, and this may influence the occurrence of mesh erosion [27]. Nonetheless, two retrospective cohort studies comparing the mesh erosion rates after SCP with use of ultra-lightweight versus heavier-weight polypropylene mesh showed conflicting results, with an earlier recurrence observed in the ultra-lightweight mesh group [30,31]. Well-designed studies will be required to clarify this issue.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for vaginal mesh erosion after sacrocolpopexy in Korean women

Kim

Jeon

2020

PLoS ONE

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ObjectiveAlthough sacrocolpopexy (SCP) can provide durable apical support, the use of mesh may give rise to various complications, including vaginal mesh erosion. The aim of this study was to identify the risk factors for vaginal mesh erosion after SCP in Korean women. MethodsThis retrospective cohort study included 363 women who underwent SCP with type 1 polypropylene mesh. They were evaluated at 1, 4, and 12 months after surgery and then annually thereafter with respect to anatomy and complications. Univariate and multivariate analyses using the Cox proportional hazard model were performed to identify the risk factors for mesh erosion. ResultsDuring the median 2-year follow-up period, vaginal mesh erosion was found in 29 women (8.0%). Among them, 19 (65.5%) required surgical correction. Estrogenic status was the only independent risk factor for mesh erosion. The risk for mesh erosion was 4.5 times higher in premenopausal women than in menopausal women not on estrogen replacement therapy (ERT) (95% confidence intervals [CI] 1.9-10.9, p<0.01). Menopausal women on ERT also had an increased risk, with a statistically marginal significance (hazard ratio 2.5, 95% CI 0.9-6.6; p = 0.07).

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“…8,136 By contrast, areas of mesh that are under less tension undergo mesh wrinkling or buckling and associated pore collapse, resulting in a mechanically inferior tissue with concentrated regions of inflammatory cells, which could predispose to mesh exposure. 8,136,137 [H2] Mesh porosity The porous area of mesh serves as a scaffold for the subsequent ingrowth of fibrous tissue. 138 The overall porosity of mesh and pore size are factors that have been shown to influence the extent of tissue ingrowth into mesh, vascular ingrowth, collagen deposition, infiltrated cell types, and the extent of scarring.…”

Section: [H2] Local Mechanical Propertiesmentioning

confidence: 99%

Host–biomaterial interactions in mesh complications after pelvic floor reconstructive surgery

et al. 2021

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Polypropylene (PPL) mesh is widely used in pelvic floor reconstructive surgery for prolapse and stress urinary incontinence. However, some women, particularly those women treated using transvaginal PPL mesh placement for prolapse, experience intractable pain and mesh exposure or extrusion. Explanted tissue from patients with complications following transvaginal implantation of mesh is typified by a dense fibrous capsule with an immune-cell rich infiltrate suggesting that the host immune response has a role in transvaginal PPL mesh complications through the separate contributions of the host (patient), the biological niche within which the material is implanted, and biomaterial properties of the mesh. This immune response might be strongly influenced by both the baseline inflammatory status of the patient, surgical technique and experience, and the unique hormonal, immune and microbial tissue niche of the vagina. Mesh porosity, surface area and stiffness also might have an effect on the immune and tissue response to transvaginal mesh placement. Thus, a regulatory pathway is needed for mesh development that recognizes the roles of host and biological factors in driving the immune response to mesh alongside mandatory mesh registries and the longitudinal surveillance of patients.

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Polypropylene Mesh Predicts Mesh/Suture Exposure After Sacrocolpopexy Independent of Known Risk Factors: A Retrospective Case-Control Study

Cited by 8 publications

References 22 publications

Laparoscopic sacrocolpopexy versus abdominal sacrocolpopexy for vaginal vault prolapse: long-term follow-up of a randomized controlled trial

Laparoscopic sacrocolpopexy versus abdominal sacrocolpopexy for vaginal vault prolapse: long-term follow-up of a randomized controlled trial

Risk factors for vaginal mesh erosion after sacrocolpopexy in Korean women

Host–biomaterial interactions in mesh complications after pelvic floor reconstructive surgery

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