Save
Comparison of mesh exposure rate required surgical intervention of transvaginal mesh(TVM) and laparoscopic abdominal sacral colpopexy (ASC)
IUGA Academy. Lee Y. Jun 30, 2018; 212866; 276 Topic: Vaginal Mesh Complications
Yi-Ling Lee
Yi-Ling Lee

Access to Premium content is currently a membership benefit.


Click here to join IUGA or renew your membership.

Abstract
Discussion Forum (0)
Rate & Comment (0)

276

Comparison of mesh exposure rate required surgical intervention of transvaginal mesh(TVM) and laparoscopic abdominal sacral colpopexy (ASC)

Li, Y1; Huang, K1

1: Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University,

Introduction: We conducted a medium-term assessment of mesh exposure rate after surgical repair of pelvic organ prolapse (POP) using transvaginal mesh (TVM) and laparoscopic abdominal sacral colpopexy (LASC) and sought to determine which surgical method and whether preserving cervix clinically influenced the outcome of pelvic reconstruction in patients.

Objective: To examine the rate of mesh exposure and invasive re-intervention after the placement of mesh between the transvaginal mesh(TVM) and laparoscopic abdominal sacral colpopexy(LASC) in more than one year follow up.

Methods: This investigation was an observational cohort study at inpatient and ambulatory surgery in our hospital. Participants were women who underwent TVM or laparoscopic ASC for pelvic organ prolapse with artificial polypropylene mesh from Jan. 2011 to Oct. 2016. We enrolled 728 and 102 women with pelvic organ prolapse, Prolapse Quantification (POP-Q) stage 2 or higher, who received transvaginal pelvic floor reconstruction surgery or laparoscopic abdominal sacral colpopexy respectively and compared the mesh exposure rate which required surgical intervention in 1 to 5 years follow up.

Results: Among the trans-vaginal mesh group, 701 cases, 343 patients (48.9 %) underwent concurrent transvaginal hysterectomy, 137 (19.5%) had prior hysterectomy history, 8 (1.1%) had previous subtotal hysterectomy and the uterus was preserved in 213 patients (30.3%). Among the laparoscopic abdominal sacral colpopexy group, 102 cases, 35 patients (34.3%) underwent concurrent laparoscopic assisted vaginal hysterectomy, 20 patients (19.6%) underwent concurrent subtotal hysterectomy, one patient had prior hysterectomy and 46 patients (45%) preserved uterus. We assessed the rate of mesh exposure which required surgical intervention of different surgical methods. The risk of mesh exposure was higher in the laparoscopic abdominal sacral colpopexy (7.8%) than transvaginal mesh (1.2%; P<0.005). In addition, among the laparoscopic abdominal sacral colpopexy group, we compared the mesh exposure rate in cervix preserved group included concurrent subtotal hysterectomy or preserved uterus (1.5 %) to LAVH group (19.4 %), which revealed significant lower ( P<0.005); furthermore, we also compared the mesh exposure rate between the laparoscopic abdominal sacral colpopexy with cervix preserved group and transvaginal mesh with uterus preserved group, there was no significant difference. Among the transvaginal mesh group, with (1.4%) or without transvaginal hysterectomy (0.9%), the rate of mesh exposure revealed no significant difference.

Conclusions: The results of our study showed that preserving cervix will decrease the rate of mesh exposure. Moreover, comparing to laparoscopic abdominal sacral colpopexy, transvaginal mesh is a safe and feasible way for pelvic floor reconstruction surgery with lower mesh exposure rate.

Surgical method

mesh exposure rate

P value

LASC vs TVM

8/102 (7.8%)

9/701 (1.2%)

P<0.005

LASC + subtotal hysterectomy or preserve uterus vs LASC + LAVH

1/66 (1.5%)

7/36 (19.4%)

P<0.005

TVM+VTH vs TVM + preserve uterus

5/343 (1.4%)

2/213 (0.9%)

P>0.005

LASC + subtotal hysterectomy or preserve uterus vs TVM

1/66 (1.5%)

9/701 (1.2%)

P>0.005

LASC+ subtotal hysterectomy or preserve uterus vs TVM+preserve uterus

1/66 (1.5%)

2/213 (0.9%)

P>0.005

Disclosure:

Work supported by industry: no.

Code of conduct/disclaimer available in General Terms & Conditions
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.


Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.



Google Analytics is used for user behavior tracking/reporting. Google Analytics works in parallel and independently from MLG’s features. Google Analytics relies on cookies and these cookies can be used by Google to track users across different platforms/services.


Save Settings