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Mesh complications after total vs supracervical laparoscopic hysterectomy at time of minimally invasive sacrocolpopexy

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Abstract

Introduction and hypothesis

Our objective was to compare mesh exposure rates (4 months and 1 year) after total (TLH) vs supracervical (SLH) laparoscopic hysterectomy at time of minimally invasive sacrocolpopexy (SCP). Secondary outcomes included 30-day complications and midurethral mesh exposure rates.

Methods

This a retrospective cohort study at a tertiary care referral center from 2011 to 2018. Subjects were identified using Current Procedural Terminology codes. Demographics, operative characteristics, and perioperative complications were abstracted from medical records.

Results

Four hundred three women met the inclusion criteria: 91 SLH+SCP and 312 TLH+SCP. Median follow-up was 52 weeks with an overall mesh exposure rate of 1.5%. Follow-up was available for 90% of patients at 4 months and 51% at 1 year. Half of patients had lightweight mesh (n = 203), and half had ultralightweight mesh (n = 200). Vaginal mesh fixation was performed with permanent suture in 86% (n = 344) and delayed absorbable suture in 14% (n = 56) of patients. At 4 months, vaginal mesh exposure rates did not differ between groups (0% SLH vs 1% TLH, p = 1.00). All mesh exposures in the study period occurred with lightweight mesh in the TLH arm. No differences were noted in 1-year mesh exposure rates, 30-day perioperative complications (p = 0.57), or midurethral mesh exposure rates at 4 months (p = 0.35) and 1 year (p = 1.00) between groups.

Conclusions

Short-term mesh exposure following SCP with ultralightweight and lightweight polypropylene mesh is rare regardless of type of hysterectomy and much lower than reported in earlier studies with heavier weight mesh. These data suggest TLH at the time of SCP is a safe option in appropriately counseled patients.

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References

  1. Wu JM, Vaughan CP, Goode PS, et al. Prevalence and trends of symptomatic pelvic floor disorders in US women. Obstet Gynecol. 2014;123(1):141–8. https://doi.org/10.1097/AOG.0000000000000057.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;2013(4). https://doi.org/10.1002/14651858.CD004014.pub5.

  3. Linder BJ, El-Nashar SA, Mukwege AA, et al. Long-term outcomes and predictors of failure after surgery for stage IV apical pelvic organ prolapse. Int Urogynecol J. 2018;29(6):803–10. https://doi.org/10.1007/s00192-017-3482-5.

    Article  PubMed  Google Scholar 

  4. Slopnick EA, Roberts K, Sheyn DD, Chapman GC, El-Nashar S, Mahajan ST. Factors influencing selection of concomitant total versus supracervical hysterectomy at the time of sacrocolpopexy and associated perioperative outcomes. Female Pelvic Med Reconstr Surg 2020;0(0):1-6. https://doi.org/10.1097/SPV.

  5. Warner W. B; Vora, Sonali; Hurtado, Eric A.; Welgoss, Jeffrey A.; Horbach, Nicolette S; 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.

    Article  PubMed  Google Scholar 

  6. Unger CA, Paraiso MFR, Jelovsek JE, Barber MD, Ridgeway B. Perioperative adverse events after minimally invasive abdominal sacrocolpopexy. Am J Obstet Gynecol. 2014;211(5):547.e1–8. https://doi.org/10.1016/j.ajog.2014.07.054.

    Article  Google Scholar 

  7. 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 

  8. Nygaard I, Brubaker L. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;82(4):757–8. https://doi.org/10.1016/j.urology.2013.06.036.

    Article  Google Scholar 

  9. Cundiff GW, Varner E, Visco AG, et al. 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.

    Article  Google Scholar 

  10. Osmundsen BC, Clark A, Goldsmith C, et al. Mesh erosion in robotic sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2012;18(2):86–8. https://doi.org/10.1097/SPV.0b013e318246806d.

    Article  PubMed  Google Scholar 

  11. Crane AK, Geller EJ, Sullivan S, et al. Short-term mesh exposure after robotic sacrocolpopexy with and without concomitant hysterectomy. South Med J. 2014;107(10):603–6. https://doi.org/10.14423/SMJ.0000000000000170.

    Article  CAS  PubMed  Google Scholar 

  12. 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 

  13. Myers EM, Siff L, Osmundsen B, Geller E, Matthews CA. Differences in recurrent prolapse at 1 year after total vs supracervical hysterectomy and robotic sacrocolpopexy. Int Urogynecol J Pelvic Floor Dysfunct. 2015;26(4):585–9. https://doi.org/10.1007/s00192-014-2551-2.

    Article  Google Scholar 

  14. Matthews CA, Geller EJ, Henley BR, et al. 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  CAS  PubMed  Google Scholar 

  15. Natale E, Illiano E, Marchesi A, Costantini E. Prospective randomized controlled trial comparing the effect of total vs subtotal hysterectomy associated with laparoscopic colposacropexy. Eur Urol Suppl. 2019;18(9):e3174–5. https://doi.org/10.1016/s1569-9056(19)33510-9.

    Article  Google Scholar 

  16. Culligan PJ, Lewis C, Priestley J, Mushonga N. Long-term outcomes of robotic-sssisted laparoscopic sacrocolpopexy using lightweight Y-mesh. Female Pelvic Med Reconstr Surg. 2020;26(3):202–6. https://doi.org/10.1097/SPV.

    Article  PubMed  Google Scholar 

  17. Kenton K, Mueller ER, Tarney C, Bresee C, Anger JT. One-year outcomes after minimally invasive sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2016;22(5):382–4. https://doi.org/10.1097/SPV.0000000000000300.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Stepanian AA, Miklos JR, Moore RD, Mattox TF. Risk of mesh extrusion and other mesh-related complications after laparoscopic sacral colpopexy with or without concurrent laparoscopic-assisted vaginal hysterectomy: experience of 402 patients. J Minim Invasive Gynecol. 2008;15(2):188–96. https://doi.org/10.1016/j.jmig.2007.11.006.

    Article  PubMed  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. Brown O, Mou T, Das D, Collins S, Kenton K, Bretschneider CE. Perioperative outcomes of laparoscopic sacrocolpopexy with and without hysterectomy: a secondary analysis of the National Surgical Quality Improvement Program Database. Int Urogynecol J. 2021. https://doi.org/10.1007/s00192-021-04675-4.

  21. Giugale LE, Hansbarger MM, Askew AL, Visco AG, Shepherd JP, Bradley MS. Assessing pelvic organ prolapse recurrence after minimally invasive sacrocolpopexy: does mesh weight matter? Int Urogynecol J. 2021. https://doi.org/10.1007/s00192-021-04681-6.

  22. Miklos JR, Chinthakanan O, Moore RD, et al. The IUGA/ICS classification of synthetic mesh complications in female pelvic floor reconstructive surgery: a multicenter study. Int Urogynecol J. 2016;27(6):933–8. https://doi.org/10.1007/s00192-015-2913-4.

    Article  PubMed  Google Scholar 

  23. Askew AL, Visco AG, Weidner AC, Truong T, Siddiqui NY, Bradley MS. Does mesh weight affect time to failure after robotic-assisted laparoscopic sacrocolpopexy? Female Pelvic Med Reconstr Surg. 2020;26(9):536–40. https://doi.org/10.1097/SPV.

    Article  PubMed  Google Scholar 

  24. Cardenas-Trowers O, Stewart JR, Meriwether KV, Francis SL, Gupta A. Perioperative outcomes of minimally invasive sacrocolpopexy based on route of concurrent hysterectomy: a secondary analysis of the National Surgical Quality Improvement Program Database. J Minim Invasive Gynecol. 2020;27(4):953–8. https://doi.org/10.1016/j.jmig.2019.08.010.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, 250 E Superior St, 5th Floor, Suite 05-2113, Chicago, IL, 60611, USA

    Deepanjana Das, Allison Carroll, Margaret Mueller, Kimberly Kenton, Christina Lewicky-Gaupp, Sarah Collins, Julia Geynisman-Tan & C. Emi Bretschneider

Authors
  1. Deepanjana Das
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  2. Allison Carroll
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  3. Margaret Mueller
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  4. Kimberly Kenton
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  5. Christina Lewicky-Gaupp
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  6. Sarah Collins
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  7. Julia Geynisman-Tan
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  8. C. Emi Bretschneider
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Contributions

D Das: Project development, Data collection, Data analysis, Manuscript writing

A Carroll: Data collection

M Mueller: Project development, Data collection, Data analysis, Manuscript editing

K Kenton: Data collection, Data analysis, Manuscript editing

C Lewicky-Gaupp: Data collection

S Collins: Data collection

J Geynisman-Tan: Data collection

CE Bretschneider: Project development, Data collection, Data analysis, Manuscript writing

Corresponding author

Correspondence to Deepanjana Das.

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Conflicts of interest

Dr. Mueller receives institutional grant funding from NIDDK and NIH, is a consultant for Caldera, is an expert witness for Butler Snow, and serves on the AUGS Board of Directors. Dr. Kenton receives institutional grant funding from NIDDK and Axonics, receives royalties from Up to Date, and is an expert witness for Butler Snow and Ethicon. Dr. Collins is a consultant for Johnson and Johnson and MCG Health. Dr. Geynisman-Tan receives institutional grant funding from Coloplast and Axonics. Dr. Bretschneider is a consultant for Boston Scientific. Dr. Das, Ms. Carroll, and Dr. Lewicky-Gaupp have no disclosures.

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Das, D., Carroll, A., Mueller, M. et al. Mesh complications after total vs supracervical laparoscopic hysterectomy at time of minimally invasive sacrocolpopexy. Int Urogynecol J 33, 2507–2514 (2022). https://doi.org/10.1007/s00192-022-05251-0

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  • DOI: https://doi.org/10.1007/s00192-022-05251-0

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