CHARLESTON, S.C. – Native tissue, vaginal mesh, and abdominal mesh repairs may all be viable treatment options for repeat surgery after failed pelvic organ prolapse repair when used in appropriately selected patients, findings from a retrospective study of 63 cases has shown.
Of 20 patients with a failed initial vaginal mesh procedure, 1 underwent repeat vaginal mesh placement in a different compartment, 10 underwent sacrocolpopexy, and 9 had a native tissue procedure for their repeat surgery. Of 43 patients with a failed initial native tissue procedure, 2 underwent a vaginal mesh repair; 33, sacrocolpopexy; and 8, a repeat native tissue procedure for their repeat surgery, Dr. Lee A. Richter reported at the annual meeting of the Society of Gynecologic Surgeons.
All patients achieved objective success. Mean Pelvic Organ Prolapse Quantification (POP-Q) scores were significantly improved for all patients following their repeat surgery, regardless of the type of initial repair and the type of repeat surgery, and none of the patients required additional surgery or pessary use during follow-up, said Dr. Richter, a fourth-year urology resident at Medstar Washington (D.C.) Hospital Center.
At 1-year follow-up, mean POP-Q measurements at anterior point B improved by 2.18 and 2.25 points in the patients treated initially with native tissue and vaginal mesh, respectively (despite significantly worse preoperative anterior prolapse in the native tissue group). Measurements at posterior point B improved by 2.63 and 2.35 points in the groups, respectively; and measurements at the cervix or vaginal cuff were improved by 8.10 and 7.65 points in the groups.
No major perioperative or postoperative complications occurred.
Of note, the time to repeat surgery was 123 months for those who initially underwent native tissue repair, compared with 30 months for those who initially underwent vaginal mesh repair, Dr. Richter noted at the meeting, jointly sponsored by the American College of Surgeons.
Patients included in the study were treated between 2008 and 2011 for failed initial vaginal native tissue or vaginal mesh repair. Most (63%) were referred from outside institutions for the repeat surgery.
The findings are important because regardless of whether mesh or native tissue is used, surgery for pelvic organ prolapse is not always successful, Dr. Richter said, noting that 13% of patients require reoperation within 5 years, and 29% require reoperation at some point during their lifetime.
In this study, native tissue repair was associated with more anterior failures than vaginal mesh, but total reoperation rates were highest for vaginal mesh.
Although the majority of patients with failed initial procedures were treated with sacrocolpopexy, native tissue and vaginal mesh repairs were equally successful for reoperation.
Dr. Richter reported having no relevant financial disclosures.