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Effect of mesh width on apical support after sacrocolpopexy

International Urogynecology Journal volume 28, pages 1153–1158 (2017)Cite this article

Abstract

Introduction and hypothesis

We evaluated the effect of polypropylene mesh width on vaginal apical support, mesh elongation, and mesh tensile strength for abdominal sacrocolpopexy.

Methods

Abdominal sacrocolpopexy was performed on ten cadavers using pieces of polypropylene mesh of width 1, 2, and 3 cm. Weights of 1, 2, 3, and 4 kg were sequentially applied to the vagina. The total distance moved by the vaginal apex, and the amount of stretch of the intervening mesh segment between the sacrum and the vagina were recorded for each width. The failure strengths of additional single and double layer sets of each width were also tested using a tensiometer. Data were analyzed with analysis of variance using a random effects model.

Results

The mean (standard error of the mean) maximum distance moved by the vaginal apex was 4.63 cm (0.37 cm) for the 1 cm mesh compared to 3.67 cm (0.26 cm) and 2.73 cm (0.14 cm) for the 2 and 3 cm meshes, respectively (P < 0.0001). The 1 cm width ruptured during testing in four of the ten cadavers. The results were similar for mesh elongation, with the 1 cm mesh stretching the most and the 3 cm mesh stretching the least. Mesh failure loads for double-layer mesh were 52.9 N (2.5 N), 124.4 N (2.7 N), and 201.2 N (4.5 N) for the 1, 2, and 3 cm meshes, respectively, and were higher than the failure loads for single mesh (P < 0.001).

Conclusions

In a cadaver model, increasing mesh width is associated with better vaginal apical support, less mesh elongation, and higher failure loads. Mesh widths of 2–3 cm provide sufficient repair strength for sacrocolpopexy.

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References

  1. Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013(4), CD004014.

  2. Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, Gantz M, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309:2016–2024.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  3. Nygaard IE, McCreery R, Brubaker L, Connolly A, Cundiff G, Weber AM, et al. Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol. 2004;104:805–823.

    Article  PubMed  Google Scholar 

  4. O’Sullivan OE, Matthews CA, O’Reilly BA. Sacrocolpopexy: is there a consistent surgical technique? Int Urogynecol J. 2016;27:747–750.

    Article  PubMed  Google Scholar 

  5. Iglesia CB, Fenner DE, Brubaker L. The use of mesh in gynecologic surgery. Int Urogynecol J Pelvic Floor Dysfunct. 2013;8:105–115.

    Article  Google Scholar 

  6. US Food and Drug Administration. Update on serious complications associated with transvaginal placement of surgical mesh for pelvic organ prolapse: FDA Safety Communication. 2011. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm262435.htm. Accessed 21 Dec 2016.

  7. Ulrich D, Edwards SL, Alexander DLJ, Rosamilia A, Werkmeister JA, Gargett CE, et al. Changes in pelvic organ prolapse mesh mechanical properties following implantation in rats. Am J Obstet Gynecol. 2016;214:260.e1–260.e8.

    Article  Google Scholar 

  8. Jones KA, Feola A, Meyn L, Abramowitch SD, Moalli PA. Tensile properties of commonly used prolapse meshes. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:847–853.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Shepherd JP, Feola A, Abramowitch SD, Moalli PA. Uniaxial biomechanical properties of seven different vaginal implanted meshes for pelvic organ prolapse. Int Urogynecol J. 2012;23:613–620.

    Article  PubMed  Google Scholar 

  10. Culligan PJ, Salamon C, Priestley JL, Shariati A. Porcine dermis compared with polypropylene mesh for laparoscopic sacrocolpopexy. Obstet Gynecol. 2013;121:143–151.

    Article  PubMed  Google Scholar 

  11. Medina CA, Pietro PA, Whitted RW, Penalver M. The use of dura mater allografts for abdominal sacral colpopexy. J Pelvic Surg. 2002;8:247–251.

    Google Scholar 

  12. Timmons MC, Addison WA, Addison SB, Cavenar MG. Abdominal sacral colpopexy in 163 women with posthysterectomy vaginal vault prolapse and enterocele: evolution of operative techniques. J Reprod Med. 1992;37:323–327.

    CAS  PubMed  Google Scholar 

  13. Deprest J, Zheng F, Konstantinovic M, Spelzini F, Claerhout F, Steensma A, et al. The biology behind fascial defects and the use of implants in pelvic organ prolapse repair. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17:S16–S25.

    Article  PubMed  Google Scholar 

  14. LeVeen HH, Barbiero JR. Tissue reaction to plastics used in surgery with special reference to Teflon. Ann Surg. 1949;129:74–84.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  15. White AB, Karrick KS, Corton MM, McIntire DD, Word RA, Rahn DD, et al. Optimal location and orientation of suture placement in abdominal sacrocolpopexy. Obstet Gynecol. 2009;113:1098–1103.

    Article  PubMed  Google Scholar 

  16. Rahn DD, Stone RJ, Vu AK, White AB, Wai CY. Abdominal hysterectomy with or without angle stitch: correlation with subsequent vaginal vault prolapse. Am J Obstet Gynecol. 2008;199:669.e1–669.e4.

    Article  Google Scholar 

  17. Rodeheaver GT, Thacker JG, Owen J, Strauss M, Masterson T, Edlich RF. Knotting and handling characteristics of coated synthetic absorbable sutures. J Surg Res. 1983;35:525–530.

    CAS  Article  PubMed  Google Scholar 

  18. Barber MD, Maher C. Apical prolapse. Int Urogynecol J. 2013;24:1815–1833.

    Article  PubMed  Google Scholar 

  19. Addington WR, Stephens RE, Phelipa MM, Widdicombe JG, Ockey RR. Intra-abdominal pressures during voluntary and reflex cough. Cough. 2008;4:2. doi:10.1186/1745-9974-4-2.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Rempen A, Kraus M. Measurement of head compression during labor: preliminary results. J Perinat Med. 1991;19:115–120.

    CAS  Article  PubMed  Google Scholar 

  21. Woodruff AJ, Roth CC, Winters JC. Abdominal sacral colpopexy: surgical pearls and outcomes. Curr Urol Rep. 2007;8:399–404.

    Article  PubMed  Google Scholar 

  22. Brizzolara S, Pillai-Allen A. Risk of mesh erosion with sacral colpopexy and concurrent hysterectomy. Obstet Gynecol. 2003;102:306–310.

    PubMed  PubMed Central  Google Scholar 

  23. Iosof CS. Abdominal sacral colpopexy with use of synthetic mesh. Acta Obstet Gynecol Scand. 1993;72:214–217.

    Article  Google Scholar 

  24. Good MM, Abele TA, Balgobin S, Montoya TI, McIntire DD, Corton MM. Vascular and ureteral anatomy relative to the midsacral promontory. Am J Obstet Gynecol. 2013;208:486.e1–486.e7.

    Article  Google Scholar 

  25. Pilsgaard K, Mouritsen L. Follow up after repair of vaginal vault prolapse with abdominal colposacropexy. Acta Obstet Gynecol Scand. 1999;78:66–70.

    CAS  Article  PubMed  Google Scholar 

  26. Salamon CG, Lewis C, Priestley J, Gurshumov E, Culligan PJ. Prospective study of an ultra-lightweight polypropylene Y mesh for robotic sacrocolpopexy. Int Urogynecol J. 2013;24:1371–1375.

    Article  PubMed  Google Scholar 

  27. Schofield ML, Higgs P, Hawnaur JM. MRI findings following laparoscopic sacrocolpopexy. Clin Radiol. 2005;60:333–339.

    CAS  Article  PubMed  Google Scholar 

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Affiliations

  1. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9032, USA

    Sunil Balgobin, Joseph L. Fitzwater, Donald D. McIntire & Clifford Y. Wai

  2. Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Imelda J. Delgado

Authors
  1. Sunil Balgobin
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  2. Joseph L. Fitzwater
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  3. Donald D. McIntire
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  4. Imelda J. Delgado
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  5. Clifford Y. Wai
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Correspondence to Sunil Balgobin.

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Balgobin, S., Fitzwater, J.L., McIntire, D.D. et al. Effect of mesh width on apical support after sacrocolpopexy. Int Urogynecol J 28, 1153–1158 (2017). https://doi.org/10.1007/s00192-016-3250-y

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  • DOI: https://doi.org/10.1007/s00192-016-3250-y

Keywords

  • Biomechanics
  • Mesh width
  • Polypropylene mesh
  • Sacrocolpopexy