Gemma Nightingale1, Christian Phillips2,3. 1. Basingstoke and North Hampshire Hospital, Basingstoke, UK. dr.g.nightingale@gmail.com. 2. Basingstoke and North Hampshire Hospital, Basingstoke, UK. 3. University of Winchester, Winchester, UK.
Abstract
INTRODUCTION AND HYPOTHESIS: Concerns regarding the use of vaginal mesh for prolapse have led to questions about the safety and efficacy of abdominally placed mesh. Mesh procedures for treating apical prolapse have become popular, either a laparoscopic hysteropexy (LSH) for uterine prolapse or a sacrocolpopexy (LSC) for vaginal vault prolapse. Robust long-term safety and efficacy data for these procedures are essential. METHODS: All patients who had LSH or LSC since 2010 were invited back for face-to-face review and examination. Case notes were reviewed for surgical morbidities and patients were questioned about short- and long-term complications. The Patient Global Impression of Improvement (PGI-I) scale was used to assess prolapse, bladder and bowel symptoms postoperatively. RESULTS: One hundred twelve patients were included in the review, 93 of whom were examined. The median time since surgery was 6 years (range 1-9 years); 2.7% cases had an intraoperative complication, two conversions to laparotomy and one bladder injury. Overall, 17.3% patients sought medical review postoperatively, with 10.7% having problems with their skin incisions. With regard to mesh safety, there was one case of bowel obstruction requiring resection following LSH and two vaginal mesh exposures following LSC; 97% had stage 1 or less apical prolapse at long-term follow-up and 79.6% reported symptoms of prolapse to be 'much better' or 'very much better' on the PGI-I scale. CONCLUSIONS: This study shows excellent long-term results from LSC and LSH with comprehensive follow-up, demonstrating a very low and acceptable level of intraoperative, short- and long-term complications.
INTRODUCTION AND HYPOTHESIS: Concerns regarding the use of vaginal mesh for prolapse have led to questions about the safety and efficacy of abdominally placed mesh. Mesh procedures for treating apical prolapse have become popular, either a laparoscopic hysteropexy (LSH) for uterine prolapse or a sacrocolpopexy (LSC) for vaginal vault prolapse. Robust long-term safety and efficacy data for these procedures are essential. METHODS: All patients who had LSH or LSC since 2010 were invited back for face-to-face review and examination. Case notes were reviewed for surgical morbidities and patients were questioned about short- and long-term complications. The Patient Global Impression of Improvement (PGI-I) scale was used to assess prolapse, bladder and bowel symptoms postoperatively. RESULTS: One hundred twelve patients were included in the review, 93 of whom were examined. The median time since surgery was 6 years (range 1-9 years); 2.7% cases had an intraoperative complication, two conversions to laparotomy and one bladder injury. Overall, 17.3% patients sought medical review postoperatively, with 10.7% having problems with their skin incisions. With regard to mesh safety, there was one case of bowel obstruction requiring resection following LSH and two vaginal mesh exposures following LSC; 97% had stage 1 or less apical prolapse at long-term follow-up and 79.6% reported symptoms of prolapse to be 'much better' or 'very much better' on the PGI-I scale. CONCLUSIONS: This study shows excellent long-term results from LSC and LSH with comprehensive follow-up, demonstrating a very low and acceptable level of intraoperative, short- and long-term complications.
Authors: Georgina Baines; Natalia Price; Helen Jefferis; Rufus Cartwright; Simon R Jackson Journal: Int Urogynecol J Date: 2019-04-30 Impact factor: 2.894
Authors: Bernard T Haylen; Dirk de Ridder; Robert M Freeman; Steven E Swift; Bary Berghmans; Joseph Lee; Ash Monga; Eckhard Petri; Diaa E Rizk; Peter K Sand; Gabriel N Schaer Journal: Neurourol Urodyn Date: 2010 Impact factor: 2.696
Authors: Anique M J van Oudheusden; Josephine Eissing; Ivon M Terink; Maarten D H Vink; Sander M J van Kuijk; Marlies Y Bongers; Anne-Lotte W M Coolen Journal: Int Urogynecol J Date: 2022-09-16 Impact factor: 1.932