Women with advanced pelvic organ prolapse and levator ani muscle avulsion would significantly benefit from mesh repair surgery
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AbstractObjectives: Mesh repair surgery for pelvic organ prolapse (POP) was suspended in some countries due to concerns over the associated complications. However, mesh repair was shown to reduce the risk of prolapse recurrence after surgery. In light of the controversy, our aim is to identify the most appropriate group of women for mesh repair surgeries where the benefits would outweigh the risks.
Methods: A prospective observational study was conducted in women who presented with stage III or IV POP and received primary prolapse surgery from 2013-18. Transperineal ultrasound was performed before the operation and volumes were analysed to assess for the presence of levator ani muscle (LAM) avulsion. All women were counselled on either mesh repair or native tissue reconstruction. Women were followed till 5 years after the operation for mesh group and 2 years for native tissue repair group. Prolapse symptoms and pelvic organ prolapse quantification staging were assessed. The subjective and objective recurrence were compared between women with and without mesh use.
Results: A total of 154 Chinese women were recruited. 104 (67.5%) women (57 transabdominal and 47 transvaginal) and 50 (32.5%) women received mesh repair and native tissue repair surgery for their stage III or IV prolapse, respectively. 95 (61.7%) women had LAM avulsion. In all, multiple logistic regression showed mesh repair significantly reduces subjective recurrence (OR:0.20, 95% CI:0.07-0.63) and objective recurrence (OR:0.16, 95% CI:0.07-0.55). In the subgroup analysis of women with LAM avulsion, mesh repair significantly reduces subjective recurrence (OR:0.24, 95% CI:0.07-0.87) and objective recurrence (OR:0.23, 95% CI:0.09-0.57). Mesh complications rate was low and could be treated conservatively or by minor surgery.
Conclusion: Mesh repair surgery, compared with native tissue repair, significantly lowers the objective and subjective recurrence for women with stage III or IV POP by 6-fold and 5-fold. In women also with LAM avulsion, both objective and subjective recurrence reduces by 4-fold. Mesh complications rate was low and could be treated conservatively or by minor surgery. The benefit of mesh surgery for these high risk women appears to outweigh the risks of mesh complications and it could be an option for this group of women.
Acceptance Date16/08/2020
All Author(s) ListWong NKL, Cheung RYK, Lee LL, Wan OYK, Choy KW, Chan SSC
Journal nameUltrasound in Obstetrics and Gynaecology
Year2021
Month4
Volume Number57
Issue Number4
PublisherWiley
Pages631 - 638
ISSN0960-7692
eISSN1469-0705
LanguagesEnglish-United Kingdom

Last updated on 2021-16-05 at 01:06