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Outcomes of trocar-guided Gynemesh PS™ versus single-incision trocarless Polyform™ transvaginal mesh procedures

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Abstract

Introduction and hypothesis

The aim of the study was to compare rates of success, mesh exposure, and surgical re-intervention after trocar-guided Gynemesh PS™ and trocarless Polyform™ transvaginal mesh procedures.

Methods

We conducted a retrospective cohort study of all transvaginal mesh procedures performed at our centers between January 2008 and May 2012. Multiple logistic regression models were used to explore the binary outcomes of objective and subjective success rates, as well as mesh exposure and re-intervention rates, between the two procedures after adjustment for patient’s age, parity, body mass index, smoking status, previous hysterectomy, previous prolapse surgery, and follow-up time.

Results

We included 103 transvaginal mesh procedures (47 trocar-guided Gynemesh PS™ and 56 trocarless Polyform™). In both groups, Pelvic Organ Prolapse Quantification (POP-Q) scores were significantly improved after the procedure. Median follow-up was 340 days and interquartile range (IQR) 152–644. Objective success rates were 55.3 % (26/47) in the trocar group and 60.7 % (34/56) in the trocarless group (p = 0.9), whereas subjective success was 83.0 % (39/47) and 94.6 % (53/56), respectively (p = 0.1). The adjusted odds of developing mesh exposure were significantly less after trocarless transvaginal mesh procedures compared to trocar-guided ones [odds ratio (OR) 0.16, 95 % confidence interval (CI) 0.03–0.97]. Surgical re-interventions, aimed mostly at treating recurrent prolapse, mesh exposure, and latent stress urinary incontinence, were also significantly less frequent after trocarless procedures [5 patients (8.9 %) requiring re-intervention versus 15 (31.9 %), respectively, adjusted OR 0.15, 95 % CI 0.04–0.60].

Conclusions

Trocar-guided Gynemesh PS™ and trocarless Polyform™ transvaginal mesh systems result in similar objective and subjective success rates. The newer Polyform™ mesh results in significantly fewer mesh exposures and surgical re-interventions.

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Acknowledgements

Funding was obtained from the Academic Enrichment Fund of the McGill University Health Center’s Obstetrics and Gynecology Department, Montreal, QC.

Conflicts of interest

Dr. Walter is a consultant for Boston Scientific and Gynecare, Ethicon and has received financial compensation from presentations for Boston Scientific, Gynecare, and Duchesnay. Dr. Merovitz has received financial compensation from a presentation for Duschesnay. Dr. Larouche and Dr. Correa have no financial disclosure.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, McGill University Health Centre, 687 Pine Avenue West, Room F8.59, Montreal, QC, Canada, H3A 1A1

    Maryse Larouche & Jens-Erik Walter

  2. Department of Obstetrics and Gynecology, St-Mary’s Hospital, Montreal, QC, Canada

    Lisa Merovitz

  3. Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada

    José A. Correa

Authors
  1. Maryse Larouche
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  2. Lisa Merovitz
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  3. José A. Correa
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  4. Jens-Erik Walter
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Correspondence to Jens-Erik Walter.

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Larouche, M., Merovitz, L., Correa, J.A. et al. Outcomes of trocar-guided Gynemesh PS™ versus single-incision trocarless Polyform™ transvaginal mesh procedures. Int Urogynecol J 26, 71–77 (2015). https://doi.org/10.1007/s00192-014-2467-x

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