The evolution of POP surgery via vaginal access in high-volume referral centre in Russia: the way from XL to XS mesh

Abstract

Background The use of large vaginal meshes for the treatment of pelvic organ prolapse (POP) in combination with poor surgical experience are the dominating risk factors for serious postoperative complications. The main goal of this study is not only to select a safe and effective method of POP surgery, but also to form a standardized teamwork algorithm aimed at diagnosing, treating and postoperative management of patients with subsequent monitoring of their condition. Methods A retrospective study of 5031 medical history was used to evaluate the effectiveness of the quality improvement intervention. We evaluated the following indicators: type of surgery performed, duration of surgery, duration of postoperative bed-day. Interventions From 2012 to 2019, seven types of surgical techniques with the use of the mesh material were consistently used, differing in the volume of the implanted mesh material, the presence and type of simultaneous native tissue reconstructive surgery, the method of mesh fixation and the number of fixation points. Results Patients who underwent technique number “7” showed the highest result in the mean scores (33±15 scores PISQ12, 51±30 scores PFDI20) of the questionnaires, which was statistically significant in comparison with other techniques (p<0,001). The number of postoperative complications were statistically significantly higher in techniques “1” to “6” compared to “7” (p<0.001). There was no difference in supportation rate between all techniques (p=0.12). Conclusions Three-level hybrid pelvic floor reconstruction is a safe and effective procedure that can be replicated in any hospital with the appropriate skill level of the surgeo