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Complication and Reoperation Rates After Apical Vaginal Prolapse Surgical Repair: A Systematic Review

Diwadkar, Gouri B. MD; Barber, Matthew D. MD, MHS; Feiner, Benjamin MD; Maher, Christopher MD; Jelovsek, J Eric MD

doi: 10.1097/AOG.0b013e318195888d

OBJECTIVE: To compare postoperative complication and reoperation rates for surgical procedures correcting apical vaginal prolapse.

DATA SOURCES: Eligible studies were selected through an electronic literature search covering January 1985 to January 2008 using PubMed, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews and Effects.

METHODS OF STUDY SELECTION: Only clinical trials and observational studies addressing apical prolapse repair and recurrence or complication rates were included. The search was restricted to original articles published in English with 50 or more participants and a follow-up period of 3 months or longer. Oral platform and poster presentations from the American Urogynecological Society, the Society for Gynecologic Surgeons, the International Urogynecological Association, and the International Continence Society from January 2005 to December 2007 were hand searched to determine whether they were eligible for inclusion.

TABULATION, INTEGRATION, AND RESULTS: Procedures were separated into three groups: traditional vaginal surgery, sacral colpopexy, and vaginal mesh kits. Complications were classified using the Dindo grading system. Weighted averages were calculated for each Dindo grade, complication, and reoperation. Dindo grade IIIa (433/3,425 women) and IIIb (245/3,425) rates were highest in the mesh kit group owing to higher rates of mesh erosion (198/3,425) and fistulae (8/3,425). Reoperation rates for prolapse recurrence were highest in the traditional vaginal surgery group (308/7,827). The total reoperation rate was greatest in the mesh kit group (291/3, 425, 8.5%).

CONCLUSION: The rate of complications requiring reoperation and the total reoperation rate was highest for vaginal mesh kits despite a lower reoperation rate for prolapse recurrence and shorter overall follow-up.

Mesh kits for apical prolapse repair have higher complication and reoperation rates compared with traditional vaginal procedures and sacral colpopexy. Supplemental Digital Content is available in the text.

From the 1Cleveland Clinic, Cleveland, Ohio; and 2Wesley Hospital, Brisbane, Queensland, Australia.

Presented at the American Urogynecologic Society 29th Annual Scientific Meeting, September 4–6, 2008, Chicago, Illinois.

Corresponding author: Gouri B. Diwadkar, MD, Cleveland Clinic, Dept. OB/GYN – Desk A-81, 9500 Euclid Ave, Cleveland, OH 44198; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2009 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.