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Does Mesh Weight Affect Time to Failure After Robotic-Assisted Laparoscopic Sacrocolpopexy?

Askew, Amy L., MD, MPH*; Visco, Anthony G., MD; Weidner, Alison C., MD; Truong, Tracy, MS; Siddiqui, Nazema Y., MD, MHSc; Bradley, Megan S., MD§

Female Pelvic Medicine & Reconstructive Surgery: October 12, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000632
Original Article: PDF Only
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Objective The objective of this study was to compare time to anatomic failure after robotic sacrocolpopexy with use of ultralightweight versus heavier weight mesh types.

Methods We performed a retrospective cohort study of women who underwent robotic sacrocolpopexy, from January 2012 to September 2016. We compared (1) sacrocolpopexy with ultralightweight mesh (≤20 g/m2) versus (2) sacrocolpopexy with heavier weight mesh (≤35 g/m2). Our primary outcome was time to anatomic failure, defined as recurrent prolapse beyond the hymen, or retreatment for prolapse with surgery or pessary. Secondary outcomes were compartment of failure and mesh exposure. Cox proportional hazards modeling was used to estimate the hazard of failure based on mesh type.

Results Of 461 patients, 248 (53.8%) underwent sacrocolpopexy with ultralightweight mesh and 213 (46.2%) with heavier weight mesh. Failures occurred in 37 women, with 21 in the ultralightweight mesh group and 16 in the heavier weight mesh group. Time to failure was statistically significant between groups (P = 0.03). Ultralightweight mesh had twice the hazard of failure within 3 years compared with heavier weight mesh (hazard ratio, 2.15; 95% confidence interval, 1.10–4.21; P = 0.03). Among failures, use of ultralightweight mesh was associated with almost 5 times the hazard of anterior compartment failure (hazard ratio, 4.46; 95% confidence interval, 1.39–14.27; P = 0.01). There was no difference in time to posterior failure. Of 17 mesh exposures, there were fewer in the ultralightweight mesh group, although this group was followed for less time (1.6% ultralightweight vs 6.0% heavier weight, P = 0.01).

Conclusions Women receiving ultralightweight mesh are more likely to experience earlier anatomic failure in the anterior compartment.

From the *Department of Obstetrics and Gynecology, Duke University Medical Center;

Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology,

Biostatistics Core, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC; and

§Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh, Pittsburgh, PA.

Correspondence: Amy L. Askew, MD, MPH, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, 200 Trent Dr, DUMC Box 3084, Baker House 236, Durham, NC 27710. E-mail: amy.l.askew@duke.edu.

A.G.V. discloses stock ownership in NinoMed. N.Y.S. holds a research grant from Medtronic, Inc. All other authors do not have any potential conflicts of interest to report.

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