Long-term mesh erosion rate following abdominal robotic reconstructive pelvic floor surgery: a prospective study and overview of the literature.

Autor: van Zanten F; Department of Gynecology, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands. f.van.zanten@meandermc.nl.; Faculty of Electrical Engineering, Mathematics & Computer Science, Twente University, Enschede, The Netherlands. f.van.zanten@meandermc.nl., van Iersel JJ; Faculty of Electrical Engineering, Mathematics & Computer Science, Twente University, Enschede, The Netherlands.; Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands., Paulides TJC; Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands., Verheijen PM; Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands., Broeders IAMJ; Faculty of Electrical Engineering, Mathematics & Computer Science, Twente University, Enschede, The Netherlands.; Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands., Consten ECJ; Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands.; Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands., Lenters E; Department of Gynecology, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands., Schraffordt Koops SE; Department of Gynecology, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands.
Jazyk: angličtina
Zdroj: International urogynecology journal [Int Urogynecol J] 2020 Jul; Vol. 31 (7), pp. 1423-1433. Date of Electronic Publication: 2019 Jun 20.
DOI: 10.1007/s00192-019-03990-1
Abstrakt: Introduction and Hypothesis: The use of synthetic mesh in transvaginal pelvic floor surgery has been subject to debate internationally. Although mesh erosion appears to be less associated with an abdominal approach, the long-term outcome has not been studied intensively. This study was set up to determine the long-term mesh erosion rate following abdominal pelvic reconstructive surgery.
Methods: A prospective, observational cohort study was conducted in a tertiary care setting. All consecutive female patients who underwent robot-assisted laparoscopic sacrocolpopexy and sacrocolporectopexy in 2011 and 2012 were included. Primary outcome was mesh erosion. Preoperative and postoperative evaluation (6 weeks, 1 year, 5 years) with a clinical examination and questionnaire regarding pelvic floor symptoms was performed. Mesh-related complications were assessed using a transparent vaginal speculum, proctoscopy, and digital vaginal and rectal examination. Kaplan-Meier estimates were calculated for mesh erosion. A review of the literature on mesh exposure after minimally invasive sacrocolpopexy was performed (≥12 months' follow-up).
Results: Ninety-six of the 130 patients included (73.8%) were clinically examined. Median follow-up time was 48.1 months (range 36.0-62.1). Three mesh erosions were diagnosed (3.1%; Kaplan-Meier 4.9%, 95% confidence interval 0-11.0): one bladder erosion for which mesh resection and an omental patch interposition were performed, and two asymptomatic vaginal erosions (at 42.7 and 42.3 months) treated with estrogen cream in one. Additionally, 22 patients responded solely by questionnaire and/or telephone; none reported mesh-related complaints. The literature, mostly based on retrospective studies, described a median mesh erosion rate of 1.9% (range 0-13.3%).
Conclusions: The long-term rate of mesh erosion following an abdominally placed synthetic graft is low.
Databáze: MEDLINE
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