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Effect of operative technique on mesh exposure in laparoscopic sacrocolpopexy.
Female Pelvic Med Reconstr Surg. 2012 Mar-Apr; 18(2):113-7.FP

Abstract

OBJECTIVES

To determine if opening the vaginal cuff during laparoscopic sacrocolpopexy influences the rate of mesh exposure.

METHODS

A total of 390 medical records were retrospectively reviewed for demographic information, operative technique, and relevant outcomes.

RESULTS

Eleven mesh exposures (2.8%) and 14 suture extrusions (3.6%) were found, none involving visceral organs. Mesh exposure was more common when the vaginal cuff was opened, either during hysterectomy or when allowing transvaginal attachment of mesh in patients with a prior hysterectomy (4.9% vs 0.5%; relative risk [RR], 9.0, P = 0.012). In cases where concomitant hysterectomy was performed, a higher mesh exposure rate was seen in open-cuff hysterectomy (total vaginal hysterectomy/laparoscopically assisted vaginal hysterectomy) compared to supracervical hysterectomy (4.9% [9/185] vs 0% [0/92]; P = 0.032). Mesh exposure was more common when the mesh was sutured laparoscopically compared with transvaginally in patients undergoing open-cuff hysterectomy (14.3% [5/35] vs 2.7% [4/150]; RR, 5.4; P = 0.013). Permanent suture extrusion was significantly associated with laparoscopic versus transvaginal suturing of mesh (5.6% vs 0.6%; RR, 8.8; P = 0.010). Five patients underwent reoperation for mesh exposure, whereas most suture extrusions were asymptomatic; and all were managed nonsurgically.

CONCLUSIONS

We found that preserving the integrity of the vaginal cuff led to a lower incidence of mesh exposure in patients undergoing laparoscopic sacrocolpopexy. When hysterectomy is indicated, a supracervical technique should be strongly considered as the mesh exposure rate was significantly lower. If removal of the cervix is indicated, the risk for mesh exposure remains low and should not preclude total hysterectomy, though transvaginal mesh attachment may be preferable.

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Authors+Show Affiliations

Warner WB
Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, MD, USA. homegrown95@yahoo.com
Vora S
No affiliation info available
Hurtado EA
No affiliation info available
Welgoss JA
No affiliation info available
Horbach NS
No affiliation info available
von Pechmann WS
No affiliation info available

MeSH

AgedFemaleHumansHysterectomy, VaginalIncidenceLaparoscopyMiddle AgedOutcome and Process Assessment, Health CarePostoperative ComplicationsReoperationSurgical MeshSuture TechniquesTreatment Outcome

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

22453322

Citation

Warner, William B., et al. "Effect of Operative Technique On Mesh Exposure in Laparoscopic Sacrocolpopexy." Female Pelvic Medicine & Reconstructive Surgery, vol. 18, no. 2, 2012, pp. 113-7.
Warner WB, Vora S, Hurtado EA, et al. Effect of operative technique on mesh exposure in laparoscopic sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2012;18(2):113-7.
Warner, W. B., Vora, S., Hurtado, E. A., Welgoss, J. A., Horbach, N. S., & von Pechmann, W. S. (2012). Effect of operative technique on mesh exposure in laparoscopic sacrocolpopexy. Female Pelvic Medicine & Reconstructive Surgery, 18(2), 113-7. https://doi.org/10.1097/SPV.0b013e318249bd54
Warner WB, et al. Effect of Operative Technique On Mesh Exposure in Laparoscopic Sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2012 Mar-Apr;18(2):113-7. PubMed PMID: 22453322.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of operative technique on mesh exposure in laparoscopic sacrocolpopexy. AU - Warner,William B, AU - Vora,Sonali, AU - Hurtado,Eric A, AU - Welgoss,Jeffrey A, AU - Horbach,Nicolette S, AU - von Pechmann,Walter S, PY - 2012/3/29/entrez PY - 2012/3/29/pubmed PY - 2012/5/9/medline SP - 113 EP - 7 JF - Female pelvic medicine & reconstructive surgery JO - Female Pelvic Med Reconstr Surg VL - 18 IS - 2 N2 - OBJECTIVES: To determine if opening the vaginal cuff during laparoscopic sacrocolpopexy influences the rate of mesh exposure. METHODS: A total of 390 medical records were retrospectively reviewed for demographic information, operative technique, and relevant outcomes. RESULTS: Eleven mesh exposures (2.8%) and 14 suture extrusions (3.6%) were found, none involving visceral organs. Mesh exposure was more common when the vaginal cuff was opened, either during hysterectomy or when allowing transvaginal attachment of mesh in patients with a prior hysterectomy (4.9% vs 0.5%; relative risk [RR], 9.0, P = 0.012). In cases where concomitant hysterectomy was performed, a higher mesh exposure rate was seen in open-cuff hysterectomy (total vaginal hysterectomy/laparoscopically assisted vaginal hysterectomy) compared to supracervical hysterectomy (4.9% [9/185] vs 0% [0/92]; P = 0.032). Mesh exposure was more common when the mesh was sutured laparoscopically compared with transvaginally in patients undergoing open-cuff hysterectomy (14.3% [5/35] vs 2.7% [4/150]; RR, 5.4; P = 0.013). Permanent suture extrusion was significantly associated with laparoscopic versus transvaginal suturing of mesh (5.6% vs 0.6%; RR, 8.8; P = 0.010). Five patients underwent reoperation for mesh exposure, whereas most suture extrusions were asymptomatic; and all were managed nonsurgically. CONCLUSIONS: We found that preserving the integrity of the vaginal cuff led to a lower incidence of mesh exposure in patients undergoing laparoscopic sacrocolpopexy. When hysterectomy is indicated, a supracervical technique should be strongly considered as the mesh exposure rate was significantly lower. If removal of the cervix is indicated, the risk for mesh exposure remains low and should not preclude total hysterectomy, though transvaginal mesh attachment may be preferable. SN - 2151-8378 UR - https://www.unboundmedicine.com/medline/citation/22453322/Effect_of_operative_technique_on_mesh_exposure_in_laparoscopic_sacrocolpopexy_ L2 - https://doi.org/10.1097/SPV.0b013e318249bd54 DB - PRIME DP - Unbound Medicine ER -