Abstract
Introduction and hypothesis
Concerns regarding the use of vaginal mesh for prolapse have led to questions about the safety and efficacy of abdominally placed mesh. Mesh procedures for treating apical prolapse have become popular, either a laparoscopic hysteropexy (LSH) for uterine prolapse or a sacrocolpopexy (LSC) for vaginal vault prolapse. Robust long-term safety and efficacy data for these procedures are essential.
Methods
All patients who had LSH or LSC since 2010 were invited back for face-to-face review and examination. Case notes were reviewed for surgical morbidities and patients were questioned about short- and long-term complications. The Patient Global Impression of Improvement (PGI-I) scale was used to assess prolapse, bladder and bowel symptoms postoperatively.
Results
One hundred twelve patients were included in the review, 93 of whom were examined. The median time since surgery was 6 years (range 1–9 years); 2.7% cases had an intraoperative complication, two conversions to laparotomy and one bladder injury. Overall, 17.3% patients sought medical review postoperatively, with 10.7% having problems with their skin incisions. With regard to mesh safety, there was one case of bowel obstruction requiring resection following LSH and two vaginal mesh exposures following LSC; 97% had stage 1 or less apical prolapse at long-term follow-up and 79.6% reported symptoms of prolapse to be ‘much better’ or ‘very much better’ on the PGI-I scale.
Conclusions
This study shows excellent long-term results from LSC and LSH with comprehensive follow-up, demonstrating a very low and acceptable level of intraoperative, short- and long-term complications.
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References
Haylen BT, De Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29:4–20. https://doi.org/10.1002/nau.20798.
Meriwether KV, Antosh DD, Olivera CK, et al. Uterine preservation vs hysterectomy in pelvic organ prolapse surgery: a systematic review with meta-analysis and clinical practice guidelines. Am J Obstet Gynecol. 2018.
Jefferis H, Price N, Jackson S. Laparoscopic hysteropexy: 10 years’ experience. Int Urogynecol J. 2017;28:1241–8. https://doi.org/10.1007/s00192-016-3257-4.
Toozs-Hobson P, Boos K, Cardozo L. Management of vaginal vault prolapse. BJOG An Int J Obstet Gynaecol. 1998;105:13–7. https://doi.org/10.1111/j.1471-0528.1998.tb09343.x.
Maher C, Feiner B, Baessler K, et al. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev. 2016.
(No Title). https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-46.pdf. Accessed 3 Feb 2020.
Freeman RM, Pantazis K, Thomson A, et al. A randomised controlled trial of abdominal versus laparoscopic sacrocolpopexy for the treatment of post-hysterectomy vaginal vault prolapse: LAS study. Int Urogynecol J Pelvic Floor Dysfunct. 2013;24:377–84. https://doi.org/10.1007/s00192-012-1885-x.
NHS S (2017) The Scottish Independent Review of the Use, Safety and Efficacy of Transvaginal Mesh Implants in the Treatment of Stress Urinary Incontinence and Pelvic Organ Prolapse in Women Final Report.
Urogynecologic Surgical Mesh Implants | FDA. https://www.fda.gov/medical-devices/implants-and-prosthetics/urogynecologic-surgical-mesh-implants. Accessed 4 Mar 2020.
Abrams P, Cardozo L, Khoury S, Wein A (2012) Incontinence: 5th international consultation on incontinence.
Baines G, Price N, Jefferis H, et al. Mesh-related complications of laparoscopic sacrocolpopexy. Int Urogynecol J. 2019;30:1475–81. https://doi.org/10.1007/s00192-019-03952-7.
Orhan A, Ozerkan K, Vuruskan H, et al. Long-term follow-up of laparoscopic sacrocolpopexy: comparison of two different techniques used in urology and gynecology. Int Urogynecol J. 2019;30:623–32. https://doi.org/10.1007/s00192-018-03858-w.
Price N, Slack A, Jackson SR. Laparoscopic hysteropexy: the initial results of a uterine suspension procedure for uterovaginal prolapse. BJOG An Int J Obstet Gynaecol. 2010;117:62–8. https://doi.org/10.1111/j.1471-0528.2009.02396.x.
Srikrishna S, Robinson D, Cardozo L. Validation of the patient global impression of improvement (PGI-I) for urogenital prolapse. Int Urogynecol J. 2010;21:523–8. https://doi.org/10.1007/s00192-009-1069-5.
Sarlos D, Kots LV, Ryu G, Schaer G. Long-term follow-up of laparoscopic sacrocolpopexy. Int Urogynecol J Pelvic Floor Dysfunct. 2014;25:1207–12. https://doi.org/10.1007/s00192-014-2369-y.
Higgs PJ, Chua HL, Smith ARB. Long term review of laparoscopic sacrocolpopexy. BJOG An Int J Obstet Gynaecol. 2005;112:1134–8. https://doi.org/10.1111/j.1471-0528.2005.00646.x.
Ganatra AM, Rozet F, Sanchez-Salas R, et al. The current status of laparoscopic sacrocolpopexy: a review. Eur Urol. 2009;55:1089–105.
Granese R, Candiani M, Perino A, et al. Laparoscopic sacrocolpopexy in the treatment of vaginal vault prolapse: 8 years experience. Eur J Obstet Gynecol Reprod Biol. 2009.
Illiano E, Giannitsas K, Zucchi A, et al. Sacrocolpopexy for posthysterectomy vaginal vault prolapse: long-term follow-up. Int Urogynecol J. 2016;27:1563–9. https://doi.org/10.1007/s00192-016-2998-4.
Loganathan J, Fayyad A, Abdel-Fattah M. Continence surgery at the time of pelvic organ prolapse repair: a review of the literature. Obstet Gynaecol. 2019;21:21–6. https://doi.org/10.1111/tog.12533.
Glazener C, Constable L, Hemming C, et al. Two parallel, pragmatic, UK multicentre, randomised controlled trials comparing surgical options for upper compartment (vault or uterine) pelvic organ prolapse (the VUE study): study protocol for a randomised controlled trial. Trials. 2016;17:441. https://doi.org/10.1186/s13063-016-1576-x.
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This work has been presented as a poster presentation at the British Society of Urogynaecology/Royal College of Obstetrician and Gynaecologists meeting, London, UK, October 2019.
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Nightingale, G., Phillips, C. Long-term safety and efficacy of laparoscopically placed mesh for apical prolapse. Int Urogynecol J 32, 871–877 (2021). https://doi.org/10.1007/s00192-020-04374-6
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DOI: https://doi.org/10.1007/s00192-020-04374-6