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Laparoscopic sacrocolpopexy versus transvaginal mesh for recurrent pelvic organ prolapse

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Abstract

Both expert surgeons agree with the following: (1) Surgical mesh, whether placed laparoscopically or transvaginally, is indicated for pelvic floor reconstruction in cases involving recurrent advanced pelvic organ prolapse. (2) Procedural expertise and experience gained from performing a high volume of cases is fundamentally necessary. Knowledge of outcomes and complications from an individual surgeon’s audit of cases is also needed when discussing the risks and benefits of procedures and alternatives. Yet controversy still exists on how best to teach new surgical techniques and optimal ways to efficiently track outcomes, including subjective and objective cure of prolapse as well as perioperative complications. A mesh registry will be useful in providing data needed for surgeons. Cost factors are also a consideration since laparoscopic and especially robotic surgical mesh procedures are generally more costly than transvaginal mesh kits when operative time, extra instrumentation and length of stay are included. Long-term outcomes, particularly for transvaginal mesh procedures, are lacking. In conclusion, all surgery poses risks; however, patients should be made aware of the pros and cons of various routes of surgery as well as the potential risks and benefits of using mesh. Surgeons should provide patients with honest information about their own experience implanting mesh and also their experience dealing with mesh-related complications.

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Authors and Affiliations

  1. Section of Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center, Washington, DC, USA

    Cheryl B. Iglesia

  2. Departments of Ob/Gyn and Urology, Georgetown University School of Medicine, 106 Irving St NW, Suite 405 South, Washington, DC, 20010, USA

    Cheryl B. Iglesia

  3. Female Pelvic Medicine and Reconstructive Surgery Fellowship, Indiana University/Methodist Hospital, Indianapolis, IN, USA

    Douglass S. Hale

  4. Gynecology, St. Luke’s Health Network, Allentown, PA, USA

    Vincent R. Lucente

Authors
  1. Cheryl B. Iglesia
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  2. Douglass S. Hale
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  3. Vincent R. Lucente
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Corresponding author

Correspondence to Cheryl B. Iglesia.

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Iglesia, C.B., Hale, D.S. & Lucente, V.R. Laparoscopic sacrocolpopexy versus transvaginal mesh for recurrent pelvic organ prolapse. Int Urogynecol J 24, 363–370 (2013). https://doi.org/10.1007/s00192-012-1918-5

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  • DOI: https://doi.org/10.1007/s00192-012-1918-5

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