Mesh erosion less likely in prior vaginal prolapse repair

CHICAGO – The presence of scar tissue may protect against synthetic mesh erosion following vaginal prolapse repair, according to findings from a retrospective case-control study.

The findings provide further support for the existing American College of Obstetricians and Gynecologists recommendation that vaginal mesh repair should be reserved for women with recurrent prolapse, and may be helpful for preoperative counseling in these patients, according to Dr. Nicholas Kongoasa of Saint Peter’s University Hospital, New Brunswick, N.J.

"Women are four times less likely to have mesh erosion if they have previously undergone prolapse repair, and that mesh should be reserved for those who fail primary repair," Dr. Kongoasa said in an interview.

Dr. Kongoasa was unable to make his presentation at the scheduled session at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Patients in the study included all those who underwent mesh-augmented pelvic floor repair between June 1, 2008, and Dec. 31, 2011. All surgeries were performed by a single surgeon using polypropylene mesh. Of 810 mesh-augmented pelvic floor repair surgeries, 688 involved no prior vaginal prolapse surgery and 142 were in patients with a prior vaginal prolapse repair.

The two groups did not differ with respect to mean operating time, intraoperative complications, postoperative complications, hospital stay, or prolapse recurrence. Also, they were similar in terms of demographics and pelvic organ prolapse quantification staging with the exception of prior hysterectomy in the prior surgery group.

During follow-ups of 1-4.5 years, mesh erosion occurred in 10.6% of those with no prior vaginal prolapse surgery, and in 2.8% of those with prior vaginal prolapse surgery (odds ratio, 4.1).

Among those with mesh erosion, no differences were seen between those with and without prior surgery with respect to time to diagnosis or location and size of erosion.

"The large number of cases and the high odds ratio warrant that this subject be further investigated by future prospective studies," he said.

The study was limited by its retrospective nature and the fact that some patients who experienced complications may have sought care elsewhere.

As for why previous surgery may protect against mesh erosion, "my personal theory is that there is generally less blood supply to the previously operated area, and this may lead to less inflammation and reaction to the foreign body," he said.

Dr. Kongoasa reported having no disclosures.

CHICAGO – The presence of scar tissue may protect against synthetic mesh erosion following vaginal prolapse repair, according to findings from a retrospective case-control study.

The findings provide further support for the existing American College of Obstetricians and Gynecologists recommendation that vaginal mesh repair should be reserved for women with recurrent prolapse, and may be helpful for preoperative counseling in these patients, according to Dr. Nicholas Kongoasa of Saint Peter’s University Hospital, New Brunswick, N.J.

"Women are four times less likely to have mesh erosion if they have previously undergone prolapse repair, and that mesh should be reserved for those who fail primary repair," Dr. Kongoasa said in an interview.

Dr. Kongoasa was unable to make his presentation at the scheduled session at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Patients in the study included all those who underwent mesh-augmented pelvic floor repair between June 1, 2008, and Dec. 31, 2011. All surgeries were performed by a single surgeon using polypropylene mesh. Of 810 mesh-augmented pelvic floor repair surgeries, 688 involved no prior vaginal prolapse surgery and 142 were in patients with a prior vaginal prolapse repair.

The two groups did not differ with respect to mean operating time, intraoperative complications, postoperative complications, hospital stay, or prolapse recurrence. Also, they were similar in terms of demographics and pelvic organ prolapse quantification staging with the exception of prior hysterectomy in the prior surgery group.

During follow-ups of 1-4.5 years, mesh erosion occurred in 10.6% of those with no prior vaginal prolapse surgery, and in 2.8% of those with prior vaginal prolapse surgery (odds ratio, 4.1).

Among those with mesh erosion, no differences were seen between those with and without prior surgery with respect to time to diagnosis or location and size of erosion.

"The large number of cases and the high odds ratio warrant that this subject be further investigated by future prospective studies," he said.

The study was limited by its retrospective nature and the fact that some patients who experienced complications may have sought care elsewhere.

As for why previous surgery may protect against mesh erosion, "my personal theory is that there is generally less blood supply to the previously operated area, and this may lead to less inflammation and reaction to the foreign body," he said.

Dr. Kongoasa reported having no disclosures.

CHICAGO – The presence of scar tissue may protect against synthetic mesh erosion following vaginal prolapse repair, according to findings from a retrospective case-control study.

The findings provide further support for the existing American College of Obstetricians and Gynecologists recommendation that vaginal mesh repair should be reserved for women with recurrent prolapse, and may be helpful for preoperative counseling in these patients, according to Dr. Nicholas Kongoasa of Saint Peter’s University Hospital, New Brunswick, N.J.

"Women are four times less likely to have mesh erosion if they have previously undergone prolapse repair, and that mesh should be reserved for those who fail primary repair," Dr. Kongoasa said in an interview.

Dr. Kongoasa was unable to make his presentation at the scheduled session at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Patients in the study included all those who underwent mesh-augmented pelvic floor repair between June 1, 2008, and Dec. 31, 2011. All surgeries were performed by a single surgeon using polypropylene mesh. Of 810 mesh-augmented pelvic floor repair surgeries, 688 involved no prior vaginal prolapse surgery and 142 were in patients with a prior vaginal prolapse repair.

The two groups did not differ with respect to mean operating time, intraoperative complications, postoperative complications, hospital stay, or prolapse recurrence. Also, they were similar in terms of demographics and pelvic organ prolapse quantification staging with the exception of prior hysterectomy in the prior surgery group.

During follow-ups of 1-4.5 years, mesh erosion occurred in 10.6% of those with no prior vaginal prolapse surgery, and in 2.8% of those with prior vaginal prolapse surgery (odds ratio, 4.1).

Among those with mesh erosion, no differences were seen between those with and without prior surgery with respect to time to diagnosis or location and size of erosion.

"The large number of cases and the high odds ratio warrant that this subject be further investigated by future prospective studies," he said.

The study was limited by its retrospective nature and the fact that some patients who experienced complications may have sought care elsewhere.

As for why previous surgery may protect against mesh erosion, "my personal theory is that there is generally less blood supply to the previously operated area, and this may lead to less inflammation and reaction to the foreign body," he said.

Dr. Kongoasa reported having no disclosures.