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Transvaginal Versus Transabdominal Placement of Synthetic Mesh at Time of Sacrocolpopexy

Nosti, Patrick A. MD; Carter, Charelle M. MD; Sokol, Andrew I. MD; Tefera, Eshetu MS; Iglesia, Cheryl B. MD; Park, Amy J. MD; Gutman, Robert E. MD

Female Pelvic Medicine & Reconstructive Surgery: May/June 2016 - Volume 22 - Issue 3 - p 151–155
doi: 10.1097/SPV.0000000000000222
Original Articles

Objectives Our primary aim was to compare mesh-related complications at the time of total vaginal hysterectomy with laparoscopic sacrocolpopexy (TVH-LSC) versus laparoscopic placement of sacrocolpopexy mesh at time of laparoscopic supracervical hysterectomy (LSH-LSC). Our secondary aim was to compare operative time, intraoperative and postoperative complications, as well as subjective and objective success between these groups.

Methods We performed a retrospective cohort study with prospective follow-up for patients with uterovaginal prolapse who underwent TVH-LSC or LSH-LSC from June 2008 to July 2012. We collected baseline demographics, mesh-related complications, intraoperative and postoperative complications, and pelvic organ prolapse quantification data. We contacted patients postoperatively for telephone interviews and to request a return to the office for repeat examination.

Results One hundred eighty-two patients were included: 123 TVH-LSC and 59 LSH-LSC. There was no difference in the rate of mesh-related complications (1.6% [2/123]; 95% confidence interval, 0–3.86% vs 1.7% [1/59]; 95% confidence interval, 0–4.99%; P = 1.0). Median examination follow-up was similar between groups (9 (2–17) months TVH-LSC vs 9 (2–17) months LSH-LSC, P = 1.0).

The TVH-LSC was associated with a significantly shorter operative time (256 ± 53 vs 344 ± 81 minutes; P < 0.01). There were no differences in intraoperative or postoperative complications or subjective and objective success between groups.

Conclusions There was no difference in mesh-related complications between groups (1.6% TVH-LSC vs 1.7% LSH-LSC; P = 1.0). Vaginal mesh attachment during TVH-LSC decreased operative time by over 1 hour with no differences in intraoperative complications, reoperation for recurrent prolapse, and subjective or objective outcomes compared to LSH-LSC.

Transvaginal mesh placement is associated with a significant decrease in operative time and no difference in mesh related complications when compared to mesh placed transabdominally at the time of sacrocolpopexy.

From the *Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Women and Infants' Services, MedStar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC; and †Department of Biostatistics and Epidemiology, Medstar Health Research Institute, Hyattsville, MD.

Reprints: Patrick A. Nosti, MD, Urogynecology of Kansas City 8901 W 74th Street, Suite 280 Shawnee Mission, KS 66204. E-mail: patrick.nosti@gmail.com.

The authors have declared they have no conflicts of interest.

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