Skip to main content

Advertisement

SpringerLink
Log in

Mesh Exposure Following Vaginal Versus Laparoscopic Hysterectomy at the Time of Sacrocolpopexy

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

To compare vaginal mesh exposure rates, adverse events and composite failure within 1 year postoperatively in patients who undergo vaginal hysterectomy with vaginal mesh attachment (TVH) versus laparoscopic hysterectomy with abdominal mesh attachment (TLH) for minimally invasive sacrocolpopexy.

Methods

This multicenter retrospective cohort study is a secondary analysis of data collected retrospectively at one institution and the multicenter randomized control PACT trial. Women were excluded for no follow-up between 9 months and 2 years postoperatively or undergoing concurrent non-urogynecologic procedures.

Results

Between 2010 and 2019, 182 patients underwent TLH and 132 TVH. There were 15 (4.8%) vaginal mesh exposures: 12 (6.6%) in the TLH and 3 (2.3%) in the TVH group (p = 0.133) with zero mesh erosions. Logistic regression analysis for mesh exposure in the TLH vs. TVH groups controlling for BMI, posterior repair and surgeon training also showed no significant difference (OR 4.8, 95% CI 0.94, 24.8, p = 0.059). The overall intraoperative complication rate was low (19/314, 6.1%) with a higher rate of bladder injury in the TLH group (4.4% vs. 0.8%, p = 0.049). The TLH group had a higher rate of UTI (8.2% vs. 2.3%, p = 0.027) and clean intermittent catheterization (11% vs. 3%, p = 0.009). At 1-year follow-up, there was no difference in composite failure (6%), bulge symptoms (5%) or retreatment (1%) between groups.

Conclusions

At 1 year, there is no significant difference in vaginal mesh exposure rates between vaginal hysterectomy with vaginal mesh attachment and laparoscopic hysterectomy with abdominal mesh attachment. Both groups have equal efficacy with low rates of complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wu JM, Matthews CA, Conover MM, Pate V, Jonsson FM. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(6):1201–6. https://doi.org/10.1097/AOG.0000000000000286.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Smith FJ, Holman CD, Moorin RE, Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010;116(5):1096–100. https://doi.org/10.1097/AOG.0b013e3181f73729.

    Article  PubMed  Google Scholar 

  3. Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, Gantz M, Fine P, Menefee S, Ridgeway B, Visco A, Warren LK, Zhang M, Meikle S. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309(19):2016–24. https://doi.org/10.1001/jama.2013.4919. Erratum in: JAMA. 2013 Sep 11;310(10):1076.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. Klauschie JL, Cornella JL. Surgical treatment of vaginal vault prolapse: a historic summary and review of outcomes. Female Pelvic Med Reconstr Surg. 2012;18(1):10–7. https://doi.org/10.1097/SPV.0b013e3182404189.

    Article  PubMed  Google Scholar 

  5. Paraiso MF, Walters MD, Rackley RR, Melek S, Hugney C. Laparoscopic and abdominal sacral colpopexies: a comparative cohort study. Am J Obstet Gynecol. 2005;192(5):1752–8. https://doi.org/10.1016/j.ajog.2004.11.051.

    Article  PubMed  Google Scholar 

  6. Wang LC, Al Hussein Al Awamlh B, Hu JC, Laudano MA, Davison WL, Schulster ML, Zhao F, Chughtai B, Lee RK. Trends in mesh use for pelvic organ prolapse repair from the medicare database. Urology. 2015;86(5):885–91. https://doi.org/10.1016/j.urology.2015.08.022.

    Article  PubMed  Google Scholar 

  7. Winkelman WD, Modest AM, Richardson ML. The surgical approach to abdominal sacrocolpopexy and concurrent hysterectomy: trends for the past decade. Female Pelvic Med Reconstr Surg. 2021;27(1):e196–201. https://doi.org/10.1097/SPV.0000000000000891.

    Article  PubMed  Google Scholar 

  8. Matthews CA, Geller EJ, Henley BR, Kenton K, Myers EM, Dieter AA, Parnell B, Lewicky-Gaupp C, Mueller MG, Wu JM. Permanent compared with absorbable suture for vaginal mesh fixation during total hysterectomy and sacrocolpopexy: a randomized controlled trial. Obstet Gynecol. 2020;136(2):355–64. https://doi.org/10.1097/AOG.0000000000003884.

    Article  PubMed  CAS  Google Scholar 

  9. Tan-Kim J, Menefee SA, Luber KM, Nager CW, Lukacz ES. Prevalence and risk factors for mesh erosion after laparoscopic-assisted sacrocolpopexy. Int Urogynecol J. 2011;22(2):205–12. https://doi.org/10.1007/s00192-010-1265-3.

    Article  PubMed  Google Scholar 

  10. Warner WB, Vora S, Hurtado EA, Welgoss JA, Horbach NS, von Pechmann WS. Effect of operative technique on mesh exposure in laparoscopic sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2012;18(2):113–7. https://doi.org/10.1097/SPV.0b013e318249bd54.

    Article  PubMed  Google Scholar 

  11. Cundiff GW, Varner E, Visco AG, Zyczynski HM, Nager CW, Norton PA, Schaffer J, Brown MB, Brubaker L; Pelvic Floor Disorders Network. Risk factors for mesh/suture erosion following sacral colpopexy. Am J Obstet Gynecol. 2008;199(6):688.e1–5. https://doi.org/10.1016/j.ajog.2008.07.029.

  12. Akyol A, Akca A, Ulker V, Gedikbasi A, Kublay A, Han A, Ark HC, Numanoglu C. Additional surgical risk factors and patient characteristics for mesh erosion after abdominal sacrocolpopexy. J Obstet Gynaecol Res. 2014;40(5):1368–74. https://doi.org/10.1111/jog.12363.

    Article  PubMed  Google Scholar 

  13. Bensinger G, Lind L, Lesser M, Guess M, Winkler HA. Abdominal sacral suspensions: analysis of complications using permanent mesh. Am J Obstet Gynecol. 2005;193(6):2094–8. https://doi.org/10.1016/j.ajog.2005.07.066.

    Article  PubMed  Google Scholar 

  14. Osmundsen BC, Clark A, Goldsmith C, Adams K, Denman MA, Edwards R, Gregory WT. Mesh erosion in robotic sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2012;18(2):86–8. https://doi.org/10.1097/SPV.0b013e318246806d. Erratum in: Female Pelvic Med Reconstr Surg. 2012;18(4):255.

    Article  PubMed  Google Scholar 

  15. Nosti PA, Carter CM, Sokol AI, Tefera E, Iglesia CB, Park AJ, Gutman RE. Transvaginal versus transabdominal placement of synthetic mesh at time of sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2016;22(3):151–5. https://doi.org/10.1097/SPV.0000000000000222.

    Article  PubMed  Google Scholar 

  16. Davidson ERW, Thomas TN, Lampert EJ, Paraiso MFR, Ferrando CA. Route of hysterectomy during minimally invasive sacrocolpopexy does not affect postoperative outcomes. Int Urogynecol J. 2019;30(4):649–55. https://doi.org/10.1007/s00192-018-3790-4.

    Article  PubMed  Google Scholar 

  17. Jones K, Thompson N, Imamoglu G, Solomon E, Rastegar V, Harmanli O. Short-term outcomes of vaginal hysterectomy at the time of robotic sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2021;27(1):e223–6. https://doi.org/10.1097/SPV.0000000000000898.

    Article  PubMed  Google Scholar 

  18. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96. https://doi.org/10.1097/SLA.0b013e3181b13ca2.

    Article  PubMed  Google Scholar 

  19. Woodburn KL, Bradley SE, Ward SA, et al. Assessing the impact of vaginal hysterectomy with vaginal mesh attachment on outcomes and complications during minimally invasive sacrocolpopexy. [Short Oral 98]. Short orals. Female Pelvic Med Reconstr Surg. 2020;26(10S):S21-S77. https://doi.org/10.1097/SPV.0000000000000934.

Download references

Acknowledgements

The authors thank and acknowledge the participants and authors of the PACT study.

Author information

Authors and Affiliations

  1. Division of Female Pelvic Medicine and Reconstructive Surgery, Georgetown University/ MedStar Washington Hospital Center, Washington, DC, USA

    Katherine L. Woodburn, Andrew I. Sokol & Robert E. Gutman

  2. Division of Urogynecology and Pelvic Reconstructive Surgery, Wake Forest Baptist Health, Winston-Salem, NC, USA

    Amr Sherif El Haraki & Catherine A. Matthews

Authors
  1. Katherine L. Woodburn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amr Sherif El Haraki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrew I. Sokol
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert E. Gutman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Catherine A. Matthews
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KL Woodburn: Project development, data collection and analysis, manuscript writing.

A El Haraki: Project development, data collection, manuscript editing.

AI Sokol: Project development, manuscript editing.

RE Gutman: Project development, manuscript editing.

CA Matthews: Project development, data analysis, manuscript writing.

Corresponding author

Correspondence to Catherine A. Matthews.

Ethics declarations

Conflicts of interest

Dr. Matthews has received grant funding and consulting fees from Boston Scientific Corporation. She is an expert witness for Johnson & Johnson.

Dr. Gutman has received grant funding and consulting fees from Boston Scientific. He is an expert witness for Johnson & Johnson slings.

Dr. Sokol is an expert witness for Johnson & Johnson.

The other authors have no disclosures.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Woodburn, K.L., El Haraki, A.S., Sokol, A.I. et al. Mesh Exposure Following Vaginal Versus Laparoscopic Hysterectomy at the Time of Sacrocolpopexy. Int Urogynecol J 33, 3213–3220 (2022). https://doi.org/10.1007/s00192-022-05093-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-022-05093-w

Keywords

Search

Navigation