Introduction
Materials and methods
Study design and participants
Inclusion and exclusion criteria
Clinical evaluation
Surgical technique
Review of the literature
Statistical analysis
Results
Patients
Demographics and operative data
Total (N = 96) | RSC (n = 50)a | RSCR (n = 46) | p value | |
---|---|---|---|---|
Mean age (SD) | 62.3 (10.4) | 62.4 (9.5) | 62.2 (11.5) | 0.922 |
Mean ASA classification (SD) | 1.8 (0.5) | 1.7 (0.5) | 1.9 (0.5) | 0.112 |
Mean parity (SD) | 2.8 (1.0) | 2.8 (1.1) | 2.8 (1.0) | 0.898 |
Mean BMI (SD) | 26.1 (4.2) | 25.9 (3.7) | 26.3 (4.7) | 0.683 |
Episiotomy (%) | 51 (53.1) | 29 (58.0) | 22 (47.8) | 0.318 |
Prolapse first degree relative (%) | 35 (36.5) | 20 (40.0) | 15 (32.6) | 0.648 |
Smoking (%) | 23 (24.0) | 12 (24.0) | 11 (23.9) | 0.957 |
Sexually active (%) | 45 (46.9) | 25 (50.0) | 20 (43.5) | 0.198 |
History (%) | ||||
TVT | 5 (5.2) | 1 (2.0) | 4 (8.7) | 0.195b |
Burch colposuspension | 1 (1.0) | 1 (2.0) | 0 | 1.000b |
Hysterectomy | 34 (35.4) | 14 (28.0) | 20 (43.5) | 0.113 |
Sacrocolpopexy | 1 (1.0) | 1 (2.0) | 0 | 1.000b |
Anterior colporrhaphy | 20 (20.8) | 9 (18.0) | 11 (23.9) | 0.476 |
Posterior colporrhaphy | 19 (19.8) | 8 (16.0) | 11 (23.9) | 0.331 |
Rectopexy | 2 (2.1) | 1 (2.0) | 1 (2.2) | 1.000b |
Perineal procedure | 2 (2.1) | 0 | 2 (4.3) | 0.227b |
Sphincter procedure | 0 | 0 | 0 | N/A |
Hemorrhoidectomy | 2 (2.1) | 0 | 2 (4.3) | 0.227b |
Other abdominal surgery | 32 (33.3) | 15 (30.0) | 17 (37.0) | 0.470 |
Rectal prolapse (%) | ||||
ERP | 4 (4.2) | 0 | 4 (8.7) | 0.049b |
IRP or/and symptomatic rectocele | 49 (51.0) | 21 (42.0) | 28 (60.9) | 0.065 |
with enterocele | 15 (15.6) | 3 (6.0) | 12 (26.1) | 0.007 |
Simplified POP-Q, mean (SD) | ||||
POP-Q Ba | 2.4 (1.0) | 2.6 (0.9) | 2.4 (0.9) | 0.947 |
POP-Q Bp | 1.9 (1.0) | 1.9 (1.0) | 2.2 (1.0) | 0.149 |
POP-Q C | 2.5 (1.0) | 2.9 (0.9) | 2.3 (1.0) | 0.021 |
POP-Q D | 2.0 (1.0) | 2.4 (1.0) | 2.2 (1.0) | 0.273 |
Concomitant supracervical hysterectomy (%) | 61 (63.5) | 36 (72.0) | 25 (54.3) | 0.073 |
Conversion (%) | 2 (2.1) | 1 (2.0) | 1 (2.2) | 1.000b |
Intra-operative complications (%) | 3 (3.1) | 0 | 3 (6.5) | 0.106 |
Mean LOS, nights (SD) | 2.8 (1.2) | 2.3 (0.9) | 3.4 (1.2) | <0.0005 |
Early postoperative complications (%) | ||||
CD grade ≤ 2 | 2 (2.1) | 2 (4.0) | 0 | 0.496b |
CD grade ≥ 3 | 1 (1.0) | 1 (2.0) | 0 | 1.000b |
Mesh erosion (%) | 3 (3.1) | 2 (4.0) | 1 (2.2) | 1.000b |
Postoperative in-hospital mortality (%) | 0 | 0 | 0 | N/A |
Mesh-related complications
Age, years (ASA) | Surgical history | Procedure | Location, symptoms | CTS [11] | Defect (cm) | Examination, months | Treatment |
---|---|---|---|---|---|---|---|
50 (2) | Cervical amputation, ventral mesh rectopexy, anterior and posterior Colporrhaphy | RSC with supracervical hysterectomy | Bladder, posterior wall, symptomatic | 4B/T4/S3 | < 1 | 45.0 | Mesh resection and omental patch interposition |
77 (2) | Unknown prolapse surgery, anterior and posterior colporrhaphy | RSCR with supracervical hysterectomy | Vagina, posterior wall, asymptomatic | 2A/T4/S1 | 1 | 42.7 | Vaginal estrogen therapy twice a week |
74 (2) | Hysterectomy, posterior colporrhaphy and McCall | RSC | Vagina, posterior wall, asymptomatic | 2A/T4/S1 | < 1 | 42.3 | Expectant management |
Overview of literature
Reference | Number of patients | Material and type of mesh | Vaginal/ rectal examination mesh | Follow-up, months (median) | Mesh complication (%) | Mesh erosion (%) |
---|---|---|---|---|---|---|
Laparoscopic and robotic | ||||||
Paraiso et al. [5] | 33 L, 35 R | PP, 1 | Only vaginal | 12 | 0 L, 2f (5.7) R | 0 L, 2f (5.7) R |
Chan et al. [15] | 20 L, 16 R | PP, 1 | Only vaginal | 39 L, 16 R | 0 L, 0 R | 0 L, 0 R |
Tan-Kim et al. [16] | 58 L, 41 R | PP, 1 | Only vaginal | 12 L, 19 R | 2 (3.6) L, 2 (4.9) R | 2 (3.6) L, 2 (4.9) R |
Seror et al. [17] | 47 L, 20 R | PP, 1 | Only vaginal | 18 L, 15 R | 1 (2.1) L, 0 R | 1 (2.1) L, 0 R |
Joubert et al. [18] | 39 L, 17 R | PP, 1/PE, 3 | Only vaginal | 14.9 L, 12 R | 2 (5.1) L, 0 R | 2 (5.1) L, 0 R |
Tan-Kim et al. [19] | 32 L, 32 R | PP, 1 | Only vaginal | 12 | 1 (3.1) L, 2 (6.3) R | 1 (3.1) L, 1 (3.1) R |
Kenton et al. [20] | 33 L, 33R | PP, 1 | Only vaginal | 12 | 0 | 0 |
Laparoscopic | ||||||
Antiphon et al. [21] | 104 | PE, 3 | Only vaginal | 17 | 2 (1.9) | 0 |
Gadonneix et al. [22] | 46 | PE, 3 | Only vaginal | 24 | 0 | 0 |
Paraiso et al. [23] | 56 | PP, 1 | n/d | 13.5d | 2 (3.6) | 2 (3.6) |
Ross and Preston [24] | 51 | PP, 1 | Only vaginal | 60 | 6 (11.8) | 4 (7.8) |
Rozet et al. [25] | 325 | PE, 3 | Only vaginal | 14.5d | 8g (2.5) | 3 (0.9) |
Agarwala et al. [26] | 72 | PP, 1 | Only vaginal | 24 | 1 (1.4) | 0 |
Rivoire et al. [27] | 108 | PP, 1 | Only vaginal | 33.7d | 9 (8.3) | 7 (6.5) |
Stepanian et al. [28] | 402 | PP, 1 | n/d | 12 | 12 (3.0) | 5 (1.2) |
Deprest et al. [29] | 104a | PP, 1a | Only vaginal | 33d | 12 (11.5) | 8 (7.7)i |
Granese et al. [30] | 165 | PP, 1 | Yes, both | 43 | 7 (4.2)h | 1 (0.6) |
Loffeld et al. [31] | 20 | PP, 1 | Only vaginal | 45d | 1 (5.0) | 1 (5.0) |
North et al. [32] | 22 | PP, 1 | Only vaginal | 27.5d | 1 (4.5) | 1 (4.5) |
Akladios et al. [33] | 48 | PP, 1 | Only vaginal | 15.8d | 1 (2.2) | 1 (2.2) |
Sabbagh et al. [34] | 132 | PP, 1 | Only vaginal | 60 | 6 (4.5) | 5 (3.8) |
Maher et al. [35] | 53 | PP, 1 | Only vaginal | 24d | 1 (1.9) | 1 (1.9) |
Sergent et al. [36] | 116 | PE, 3 | Only vaginal | 34.2 | 5 (4.3) | 4 (3.4) |
Perez et al. [37] | 85 | PE, 3 | Only vaginal | 12 | 5 (5.9) | 3 (3.5) |
Price et al. [38] | 84 | PP, 1 | Only vaginal | 24d | 5 (6.0) | 5 (6.0)j |
Freeman et al. [39] | 23 | PP, 1 | Only vaginal | 12 | 0 | 0 |
Leruth et al. [40] | 55 | PE, 3 | Only vaginal | 25d | 0 | 0 |
Liu et al. [41] | 39 | PP, 1 | Only vaginal | 12 | 0 | 0 |
Park et al. [42] | 54 | PP, 1 | Only vaginal | 29.7d | 3 (5.6) | 3 (5.6) |
Sarlos et al. [43] | 68 | PP, 1 | Only vaginal | 60d | 2 (2.9) | 2 (2.9) |
El Hamamsy and Fayyad [44] | 220 | PP, 1 | Only vaginal | 12 | 2 (0.9) | 2 (0.9) |
Estrade et al. [45] | 35 | PE, 3 | Only vaginal | 13.2 | 1 (2.9) | 1 (2.9) |
Gracia et al. [46] | 30 | PP, 1 | Only vaginal | 12 | 0 | 0 |
Vieillefosse et al. [47] | 100 | PP, 1/PE, 3 | Only vaginal | 23.6 | 2 (2.0) | 2 (2.0) |
Costantini et al. [48] | 60 | PP, 1 | Only vaginal | 41.7d | 3 (5.0) | 3 (5.0) |
Dandolu et al. [3] | 4,552 | n/d | n/a | 24 | 52 (1.7) | 52 (1.7) |
Liang et al. [49] | 30 | PP, 1 | Only vaginal | 36 | 3 (10) | 3 (10) |
Lizee et al. [50] | 60 | PE, 3 | Only vaginal | 27 | 1 (1.7) | 1 (1.7) |
Vandendriessche et al. [51] | 391b | PP, 1/PE, 3 | No, telephone FU | 53.3 | 11 (2.8) | 7 (1.8) |
Zebede et al. [52] | 144 | PP, 1 | Only vaginal | 21 | 4 (2.8) | 0 |
Pan et al. [53] | 99 | PP, 1 | Only vaginal | 33d | 0 | 0 |
Chen and Hua [54] | 102 | PP, 1 | Only vaginal | 24 | 1 (1.0) | 1 (1.0) |
Robotic | ||||||
Elliott et al. [55] | 42 | PP, 1 | Only vaginal | 36d | 3 (7.1) | 2 (4.8) |
Benson et al. [56] | 33 | PP, 1 | n/d | 20.7–38.4e | 2 (6.1) | 0 |
Shveiky et al. [57] | 17 | PP, 1 | Only vaginal | 12.3 | 0 | 0 |
Xylinas et al. [58] | 12 | PP, 1 | n/d | 19.1 | 0 | 0 |
Geller et al. [59] | 15 | PP, 1 | Only vaginal | 14.8d | 2 (13.3) | 2 (13.3) |
Moreno Sierra et al. [60] | 31 | PP, 1 | Only vaginal | 24.5d | 1 (3.2) | 0 |
Shimko et al. [61] | 40 | PP, 1 | Only vaginal | 62 | 2 (5.0) | 2 (5.0) |
Geller et al. [62] | 23 | PP, 1 | Only vaginal | 44.2d | 2 (8.7) | 2 (8.7) |
Göçmen et al. [63] | 12 | PP, 1 | n/d | 12 | 0 | 0 |
Mourik et al. [64] | 50c | PP, 1 | Only vaginal | 16 | 1 (2.0) | 0 |
Siddiqui et al. [65] | 70 | PP, 1 | Only vaginal | 18.3d | 3 (4.3) | 3 (4.3) |
Belsante et al. [66] | 35 | PP, 1 | Only vaginal | 28 | 1 (2.9) | 1 (2.9) |
Louis-Sylvestre and Herry [67] | 90 | PE, 3 | n/d | 15.6d | 1 (1.1) | 1 (1.1) |
Salamon et al. [68] | 118 | PP, 1 | Only vaginal | 12 | 0 | 0 |
Barboglio et al. [69] | 127 | PP, 1 | Only vaginal | 12 | 3 (2.4) | 3 (2.4) |
Borahay et al. [70] | 20 | PP, 1 | Only vaginal | 17.3d | 0 | 0 |
Culligan et al. [71] | 143 | PP, 1 | Only vaginal | 12 | 0 | 0 |
Ploumidis et al. [72] | 95 | PP, 1 | Only vaginal | 34.8 | 1 (1.1) | 1 (1.1) |
Jambusaria et al. [73] | 30 | PP, 1 | Only vaginal | 12 | 1 (3.3) | 1 (3.3) |
Linder et al. [74] | 70 | PP, 1 | n/d | 72 | 2 (2.9) | 2 (2.9) |
Myers et al. [75] | 83 | PP, 1 | Only vaginal | 12.8 | 4 (4.8) | 4 (4.8) |
Prendergast et al. [76] | 33 | PP, 1 | Only vaginal | 12 | 2 (6.1) | 2 (6.1) |
Linder et al. [77] | 132 | PP, 1 | Only vaginal | 33 | 8 (6.1) | 8 (6.1) |