Lara C. Pullen, PhD

May 02, 2014

CHICAGO — Because scar tissue can offer protection against mesh erosion, women who require reoperation for recurrent prolapse might benefit from vaginal mesh repair, new research shows.

This is important information to have "when you are counseling women whether or not they should get the mesh," said Nicholas Bongos, MBChB, from Saint Peter's University Hospital in New Brunswick, New Jersey.

Women should be counseled to try primary repair first. If that doesn't work, mesh might be a reasonable option, he told Medscape Medical News.

Dr. Kongoasa presented the research here at the American Congress of Obstetricians and Gynecologists (ACOG) 2014 Annual Clinical Meeting.

The retrospective case–control study involved 810 cases of mesh-augmented pelvic floor repair in 518 patients from June 2008 to December 2011. A case was identified by the number of pieces of mesh placed; a patient who received a combined anterior and posterior repair with mesh in both compartments counted as 2 cases.

All surgeries were performed by the same surgeon using a uniform surgical technique and the same synthetic mesh material. Mesh erosion was defined as any exposure of mesh on visual inspection of the vagina.

Postoperative follow-up continued until December 2012, and ranged from 12 to 54 months.

Mesh erosion was more common in women who had not previously undergone vaginal prolapse surgery than in those who had (10.6% vs 2.8%; odds ratio, 4.10; 95% confidence interval, 1.47 -11.43; p = .004).

Table. Outcomes According to Vaginal Prolapse Surgery History

Outcome No Previous Surgery (n = 668) Previous Surgery (n = 142) P Value
Operating room time (min) 61.2 52.8 .253
Estimate blood loss (mL) 199.2 131.8 <.001
Intraoperative complications (%) 1 0 .449
Postoperative complications (%) 2 4 .265
Hospital stay (days) 1 0.88 .500
Recurrence of prolapse (%) 1 1 .768

 

"The finding was actually the opposite of what I expected," reported Dr. Kongoasa.

Scar tissue might protect against mesh erosion because of a decreased blood supply, which would translate into decreased bleeding and, possibly, decreased reaction to the foreign mesh body, he suggested.

According to Dr. Kongasa, approximately one-third of women experience vaginal prolapse, and 3% of them have 2 or more surgeries to treat prolapse. The high incidence of first surgery failure has caused physicians to explore the use of different materials to augment repair.

The use of mesh has resulted in a lower recurrence of prolapse; however, mesh surgeries have a high complication rate (10%), 70% of which require surgical revision.

This study is the first to compare vaginal mesh erosion in patients who have undergone previous prolapse surgery and those who have not.

"This study goes along with what ACOG has been saying," Dr. Kongoasa said. Vaginal mesh repair should be reserved for high-risk individuals, such as those with recurrent prolapse, according to recommendations issued by the ACOG and the American Urogynecologic Society.

Limitations to this study include its retrospective nature, the presence of confounding variables, and loss to follow-up.

However, "the important thing to emphasize about this study," said Caela Miller, MD, from the San Antonio Military Medical Center, is its retrospective nature. None of these women were treated after 2011, so "no new women received mesh," she told Medscape Medical News. Dr. Miller is a member of the ACOG Committee on Scientific Program.

Dr. Kongoasa and Dr. Miller have disclosed no relevant financial relationships.

American Congress of Obstetricians and Gynecologists (ACOG) 2014 Annual Clinical Meeting: Abstract 1S. Presented April 28, 2014.

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