Serious complications and recurrences after pelvic organ prolapse surgery for 2309 women in the VIGI-MESH registry

Objective: To assess the incidence of serious complications and reoperations for recurrence after pelvic organ prolapse (POP) surgery and compare the three most common types of repair. Design: Prospective cohort study using a registry. Setting: 19 surgical centres in France. Population: 2309 women participated between 2017 and 2019. Methods: a multivariate analysis including an inverse probability of treatment weighting approach was used to obtain three comparable groups. Main outcome measures: Serious complications and subsequent reoperations for POP recurrence Results: Mean follow-up was 16.6 months. Surgeries included in the analysis were native tissue vaginal repair (N=504), transvaginal mesh placement (692), and laparoscopic sacropexy with mesh (1113). Serious complications occurred among 52 women (2.3%), and reoperation for recurrence was required for 32 (1.4%). At one year, the cumulative weighted incidence of serious complications was 1.8% for native tissue vaginal repair (95% confidence interval 0-3.9), 3.9% for transvaginal mesh (2.0-5.9), and 2.2% for sacropexy (1.1-2.6). Compared with the native tissue vaginal repair group, the risk of serious complications was higher in the transvaginal mesh group (weighted-HR 3.84, 2.43-6.08), and the sacropexy group (2.48, 1.45-4.23), while the risk of reoperation for prolapse recurrence was reduced in both groups (transvaginal mesh [0.22, 0.13-0.39] and sacropexy [0.29, 0.18-0.47]). Conclusions: Laparoscopic sacropexy with mesh appears to have a better risk profile (few serious complications and few reoperations for recurrence) than transvaginal mesh placement (more serious complications) and native tissue vaginal repair (more reoperations for recurrence). These results are useful for informing women and for shared decision making.

Vaginal length after a laparoscopic sacropexy

Vaginal shortening after surgical treatment of pelvic organ prolapse is associated with dyspareunia, which negatively affects women’s sexual life as well as their psychosocial well-being. The aim of the study is to determine the vaginal length in women with high-grade pelvic organ prolapse treated with laparoscopic sacropexy. In the prospective study we included 22 women with high-grade prolapse of the uterus or vagina that were treated. They underwent a gynaecological examination with a measurement of the vaginal length, as well as the evaluation of the degree of prolapse prior to the procedure (laparoscopic sacropexy). The second measurement and evaluation of the vaginal length during the follow-up examination between 6 to 12 weeks after surgery was done. The control group included 23 healthy women, without genital prolapse. There was no statistically significant difference in the mean vaginal length before and after surgery in the group of treated women.