International Urogynecology Journal

, Volume 24, Issue 3, pp 363–370

Laparoscopic sacrocolpopexy versus transvaginal mesh for recurrent pelvic organ prolapse

  • Cheryl B. Iglesia
  • Douglass S. Hale
  • Vincent R. Lucente
Debate

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.

Keywords

Laparoscopic sacrocolpopexy Transvaginal mesh Recurrent pelvic organ prolapse 

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Copyright information

© The International Urogynecological Association 2012

Authors and Affiliations

  • Cheryl B. Iglesia
    • 1
    • 2
  • Douglass S. Hale
    • 3
  • Vincent R. Lucente
    • 4
  1. 1.Section of Female Pelvic Medicine and Reconstructive SurgeryMedStar Washington Hospital CenterWashington, DCUSA
  2. 2.Departments of Ob/Gyn and UrologyGeorgetown University School of MedicineWashington, DCUSA
  3. 3.Female Pelvic Medicine and Reconstructive Surgery FellowshipIndiana University/Methodist HospitalIndianapolisUSA
  4. 4.GynecologySt. Luke’s Health NetworkAllentownUSA

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