Standardizing abdominal sacrocolpopexy for the treatment of apical prolapse: One year on

Cassis, Charlotte; Mukhopadhyay, Sambit; Morris, Edward

doi:10.1002/ijgo.12935

Cited by 9 publications

(4 citation statements)

References 26 publications

(48 reference statements)

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“… 22 Likewise, a case series study carried out in the UK reported a lower wound infection rate of 2%. 23 This is an alarming situation that requires further investigation. Within the first 12 months of follow-up, none of our patients experienced gastrointestinal issues that required a readmission, surgery, or hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Long-term safety and efficacy of non-absorbable abdominal mesh for apical prolapse surgery: A 10-year experience at Tertiary Care Hospital

Aijaz

Chughtai²,

Kashif³

et al. 2023

Pak J Med Sci

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Objectives: To evaluate the complications of apical prolapse correction with abdominally placed mesh and to assess the long-term efficacy of Sacrohysteropexy and Sacrocolpopexy. Method: A retrospective cohort study was conducted at the Department of Gynecology and Obstetrics, Aga Khan University Hospital. All women who underwent apical prolapse surgery using abdominal mesh from January 2010 to December 2019 at AKUH were included. Patients with missing routine follow up visits and incomplete data up to one year post op were excluded. Patient notes were reviewed, and subjective and objective success and complications were analyzed. Safety was measured by incidence of intra, early and late postoperative complications and mesh-related complications of both procedures at two weeks, six months, twelve months, postoperatively. Results: A total of 69 cases were retrieved from the database with a mean age of 46.97 ± 13.86 years. It was found that 14 (20.3%) patients had wound infection while six (8.7%) patients developed urinary tract infections. In a median follow-up of 12 months, three patients developed mesh erosion as a complication, with an incidence of 4.3%. Two required surgical excision of the mesh and the third was successfully managed conservatively with topical estrogen and oral antibiotics. Extremely significant improvements were observed in POPDI-six scores six months postoperatively (p=0.0001). Conclusion: The present study signifies the use of abdominally placed mesh in patients with pelvic organ prolapse indicating significant improvement in Pelvic Organ Prolapse-associated symptoms postoperatively. doi: https://doi.org/10.12669/pjms.39.2.6689 How to cite this: Aijaz S, Chughtai N, Kashif U, Malik S. Long-term safety and efficacy of non-absorbable abdominal mesh for apical prolapse surgery: A 10-year experience at Tertiary Care Hospital. Pak J Med Sci. 2023;39(2):567-571. doi: https://doi.org/10.12669/pjms.39.2.6689 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionmentioning

confidence: 99%

Long-term safety and efficacy of non-absorbable abdominal mesh for apical prolapse surgery: A 10-year experience at Tertiary Care Hospital

Aijaz

Chughtai²,

Kashif³

et al. 2023

Pak J Med Sci

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“…The most common limiting factor, i.e., failure mode, was a mesh failure for group 1 and group 2, so that the fixation itself supported more load than the PVDF-tape. Literature does not report about any mesh erosion after PVDF-tape fixation with sutures after bilateral cervicosacropexy [ 15 , 18 , 19 , 26 ]. So from a clinical point of view, the factor “mesh failure” does not seem to have any influence on the surgical results, because follow-ups four months after surgery showed only a relapse of apical prolapse because of an insufficient cervical fixation, but all further patients had an apical POP-Q stage 0, which means that the right anatomical position could be restored and the mesh was still intact [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to Jäger et al [ 11 ] and other study groups [ 18 , 19 ] in laparoscopic approach, three instead of four interrupted sutures were used to fix the central part of the PVDF-tape on the cervix or the vaginal vault (Fig. 1 ).…”

Section: Introductionmentioning

confidence: 99%

AbsorbaTack™ vs. ProTack™ vs. sutures: a biomechanical analysis of cervical fixation methods for laparoscopic apical fixations in the porcine model

Ludwig

Alina

Thangarajah

et al. 2022

Arch Gynecol Obstet

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Purpose Treatment of pelvic organ prolapse (POP) often requires the use of synthetic mesh. In case of a novel and standardized bilateral apical fixation, both uterosacral ligaments are replaced by polyvinylidene-fluoride (PVDF) tapes. One of the main problems remains the fixation method, which should be stable, but also simple and quick to use. The current study evaluated biomechanical differences between the cervical tape fixation with sutures (group 1), non-absorbable tacks (group 2) and absorbable tacks (group 3) in an in vitro porcine model. Methods A total of 28 trials, conducted in three groups, were performed on porcine, fresh cadaver uteri. All trials were performed until mesh, tissue or fixation device failure occurred. Primary endpoints were the biomechanical properties maximum load (N), displacement at failure (mm) and stiffness (N/mm). The failure mode was a secondary endpoint. Results There was a significant difference between all three groups concerning the maximum load. Group 1 (sutures) supported a maximum load of 64 ± 15 N, group 2 (non-absorbable tacks) yielded 41 ± 10 N and group 3 (absorbable tacks) achieved 15 ± 8 N. The most common failure mode was a mesh failure for group 1 and 2 and a fixation device failure for group 3. Conclusion The PVDF-tape fixation with sutures supports 1.5 times the load that is supported by non-absorbable tacks and 4.2 times the load that is supported by absorbable tacks. Nevertheless, there was also a stable fixation through tacks. Sutures are the significantly stronger and cheaper fixation device but may prolong the surgical time in contrast to the use of tacks.

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“…Since laparoscopic suturing prolongs the operation time in laCESA or laVASA compared to the use of the fixation device with titanium tacks, the question arose if there are comparable results between the sutures, which are used as standard by Jäger et al [ 10 ] and other study groups [ 16 , 17 ] and the ProTack™ tacks and if one fixation method is superior. Moreover, the aim of this study was to find out, if there is a difference depending on how the tacks are arranged.…”

Section: Introductionmentioning

confidence: 99%

Tacks vs. sutures: a biomechanical analysis of sacral bony fixation methods for laparoscopic apical fixations in the porcine model

Jansen

Ludwig

Malter

et al. 2021

Arch Gynecol Obstet

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Purpose There is a novel surgical procedure, called cervicosacropexy (CESA) and vaginosacropexy (VASA) to treat pelvic organ prolapse and a concomitant urgency and mixed urinary incontinence. As there is little experience with the tapes so far and literature is scanty, the aim of this study was to investigate biomechanical properties for the fixation of the PVDF-tapes with three different fixation methods in context of apical fixations. Methods Evaluation was performed on porcine, fresh cadaver sacral spines. A total of 40 trials, divided into 4 subgroups, was performed on the anterior longitudinal ligament. Recorded biomechanical properties were displacement at failure, maximum load and stiffness in terms of the primary endpoints. The failure mode was a secondary endpoint. Group 4 was a reference group to compare single sutures on porcine tissue with those on human tissue. Biomechanical parameters for single sutures on the human anterior longitudinal ligament were evaluated in a previous work by Hachenberg et al. Results The maximum load for group 1 (two single sutures) was 65 ± 12 N, for group 2 (three titanium tacks arranged in a row) it was 25 ± 10 N and for group 3 (three titanium tacks arranged in a triangle) it was 38 ± 12 N. There was a significant difference between all three groups. The most common failure mode was a “mesh failure” in 9/10 trials for groups 1–3. Conclusion The PVDF-tape fixation with two single sutures endures 2.6 times more load than titanium tacks arranged in a row and 1.7 times more load than titanium tacks arranged in a triangle. The presacral fixation with titanium tacks reduced surgical time compared to the fixation with sutures, nevertheless sutures represent the significantly stronger and cheaper fixation method.

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Standardizing abdominal sacrocolpopexy for the treatment of apical prolapse: One year on

Cited by 9 publications

References 26 publications

Long-term safety and efficacy of non-absorbable abdominal mesh for apical prolapse surgery: A 10-year experience at Tertiary Care Hospital

Long-term safety and efficacy of non-absorbable abdominal mesh for apical prolapse surgery: A 10-year experience at Tertiary Care Hospital

AbsorbaTack™ vs. ProTack™ vs. sutures: a biomechanical analysis of cervical fixation methods for laparoscopic apical fixations in the porcine model

Tacks vs. sutures: a biomechanical analysis of sacral bony fixation methods for laparoscopic apical fixations in the porcine model

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