Mesh-related complications of laparoscopic lateral suspension

Objective: Restorative procedures are essential for sexually active vaginal vault prolapse (VVP) cases. There are concerns about the long learning curve and major complications of sacrocolpopexy. Laparoscopic lateral suspension has a relatively short learning curve and no reported major complications. However, there are concerns about the use of mesh in prolapse surgeries and limited data is available about mesh complications with laparoscopic lateral suspension. This study aimed to establish the mesh-related complications after laparoscopic lateral suspension. Study Design: We carried out a retrospective analysis of patients who underwent laparoscopic lateral suspension for symptomatic VVP at three tertiary hospitals. Cases were identified from theatre records with coding data and the universities database. Demographic features, concomitant procedures, duration of surgery, intra-operative complications, hospital stay, change in pelvic organ prolapse quantification point C, Patient Global Impression of Improvement scale records, mesh-related complications and their management are presented. Results: A total of 120 patients underwent laparoscopic lateral suspension for symptomatic vault prolapse between 2014-2019. In total, mesh complications developed in 3 women (2.5%). While two vaginal mesh exposures were successfully managed with topical estrogen, one required surgical excision. One lateral mesh arm was loosened from the skin causing pain and itching. From 110 Patient Global Impression of Improvement scores, 106 women (96%) described their prolapse as ‘very much’ or ‘much’ better, 4 patients (3.6 %) reported ‘no change’ and no one reported worsening of symptoms. Conclusions: This series suggests that laparoscopic lateral suspension has low risk of mesh-related complications. It is a safe and effective procedure for symptomatic vault prolapse with high rates of patient satisfaction.

Long-term mesh complications and reoperation after laparoscopic mesh sacrohysteropexy: a cross-sectional study

Introduction and hypothesis The paucity of long-term safety and efficacy data to support laparoscopic mesh sacrohysteropexy is noteworthy given concerns about the use of polypropylene mesh in pelvic floor surgery. This study is aimed at determining the incidence of mesh-associated complications and reoperation following this procedure. Methods This was a cross-sectional postal questionnaire study of women who underwent laparoscopic mesh sacrohysteropexy between 2010 and 2018. Potential participants were identified from surgical databases of five surgeons at two tertiary urogynaecology centres in the UK. The primary outcome was patient-reported mesh complication requiring removal of hysteropexy mesh. Secondary outcomes included other mesh-associated complications, reoperation rates and Patient Global Impression of Improvement (PGI-I) in prolapse symptoms. Descriptive statistics and Kaplan–Meier survival analyses were used. Results Of 1,766 eligible participants, 1,121 women responded (response proportion 63.5%), at a median follow-up of 46 months. The incidence of mesh complications requiring removal of hysteropexy mesh was 0.4% (4 out of 1,121). The rate of chronic pain service use was 1.8%, and newly diagnosed systemic autoimmune disorders was 5.8%. The rate of reoperation for apical prolapse was 3.7%, and for any form of pelvic organ prolapse it was 13.6%. For PGI-I, 81.4% of patients were “much better” or “very much better”. Conclusions Laparoscopic mesh sacrohysteropexy has a low incidence of reoperation for mesh complications and apical prolapse, and a high rate of patient-reported improvement in prolapse symptoms. With appropriate clinical governance measures, the procedure offers an alternative to vaginal hysterectomy with apical suspension. However, long-term comparative studies are still required.