Original article
Risk of Mesh Extrusion and Other Mesh-Related Complications After Laparoscopic Sacral Colpopexy with or without Concurrent Laparoscopic-Assisted Vaginal Hysterectomy: Experience of 402 Patients

https://doi.org/10.1016/j.jmig.2007.11.006Get rights and content

Abstract

Study Objective

To estimate the incidence of mesh-related complications including mesh erosion/extrusion rates in patients undergoing laparoscopic sacral colpopexy, with or without concurrent hysterectomy, using macroporous soft polypropylene mesh.

Design

Historical cohort study (Canadian Task Force classification II-2).

Setting

Private urogynecology clinic.

Patients

A total of 446 consecutive patients with uterovaginal or vaginal vault prolapse underwent laparoscopic sacral colpopexy with use of macroporous soft polypropylene mesh from January 2003 through January 2007. In all, 402 consecutive patients met enrollment criteria. Two groups of patients were identified: (1) those receiving concurrent hysterectomy (n = 130); and (2) those with a history of hysterectomy (n = 272).

Interventions

Patients were treated with laparoscopic sacral colpopexy with use of macroporous soft polypropylene mesh in conjunction with other laparoscopic and/or vaginal procedures.

Measurements and Main Results

Data were collected in the form of chart reviews and patient questionnaires. Comparisons were made between groups 1 and 2. Patient demographics, history, mesh erosion/extrusion rates, and mesh-related complications were analyzed. Length of follow-up was 1 to 54 months with a median follow-up time of 12 months. No statistically significant differences existed between 2 groups in rates of mesh erosion/extrusion or other mesh-related complications. Overall vaginal mesh erosion/extrusion rate was 1.2% (95% CI 0.5%–2.7%) with an associated mesh revision rate of 1.2% (95% CI 0.5%–2.7%). Patients with concurrent hysterectomy had an erosion/extrusion rate of 2.3% (3/130) as compared with 0.7% (2/272) in patients with a history of hysterectomy, p = .18. No cases of mesh erosion through organs and tissues other than vaginal mucosa were observed. Cuff abscess occurred in 1 patient with concurrent hysterectomy, with an overall infection rate of 0.3% (95% CI 0.01%–1.2%). One more patient developed an inflammatory reaction to the mesh. Excision of exposed mesh was performed in all 5 patients with mesh extrusion. Vaginal approach to excision was uniformly used. Laparoscopic removal of the entire mesh took place in 4 patients with persistent pelvic pain, in 1 patient with cuff abscess, and in one patient with a questionable mesh reaction. An estimated 975 to 17 000 patients were required in each group to achieve power to detect a statistically significant difference in rate of mesh-related complications in this study.

Conclusion

Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1% in our study. No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy. The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study.

Section snippets

Study Design

After receiving institutional review board approval, a historical cohort analysis of office and hospital records was performed for all patients who underwent laparoscopic sacral colpopexy from January 2003 through January 2007 at our institution. In all, 446 consecutive patients with uterovaginal or vaginal vault prolapse were treated with laparoscopic sacral colpopexy in conjunction with other laparoscopic and/or vaginal procedures. Data were collected in the form of chart reviews and patient

Results

Records were reviewed for 402 patients meeting study criteria. In all, 130 patients with concurrent hysterectomy and 272 patients with a previous hysterectomy were followed up postoperatively for 1 to 54 months. The demographic data, including age, ethnicity, gravidity and parity, weight, largest birth weight inclusive of deliveries via cesarean section, and estrogen-containing preparation use, are shown in Table 1. Data comparing patients’ surgical history in each group are provided in Table 2.

Discussion

Multiple procedures for uterovaginal and vaginal vault prolapse have been successfully performed laparoscopically. Recently conducted comparative cohort analysis indicated the comparable aspects of laparoscopic and open abdominal approaches to sacral colpopexy with respect to clinical outcomes and safety whereas the laparoscopic approach offers the benefits of minimally invasive surgery [17]. In addition to providing minimally invasive access to the peritoneal cavity [18], the laparoscopic

Conclusion

The risks of mesh-related complications associated with laparoscopic sacral colpopexy were low and equal to about 1% for mesh extrusions, infection, reaction, and apical pain. We believe that low risk of mesh-related complications is the result of use of macroporous soft knitted polypropylene mesh and strict adherence to surgical techniques indicated to decrease the risk of mesh exposure and other mesh-related complications.

No statistically significant differences in mesh-related complication

Acknowledgment

We would like to thank Dawn Blackhurst, PhD, for her statistical analysis of this study.

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