Original Article

Short-Term Mesh Exposure after Robotic Sacrocolpopexy With and Without Concomitant Hysterectomy

Authors: Andrea K. Crane, MD, Elizabeth J. Geller, MD, Stephanie Sullivan, MD, Barbara L. Robinson, MD, Erinn M. Myers, MD, Christine Horton, MD, Catherine A. Matthews, MD

Abstract

Objectives: The primary objective of this study was to compare the short-term rate of mesh exposure after a robotic sacrocolpopexy (RSCP) compared with those after RSCP with a concomitant hysterectomy. Secondary objectives included a comparison of mesh exposure from total hysterectomies (TH) versus supracervical hysterectomies (SCH) and determination of risk factors for mesh exposure.

Methods: This was a retrospective cohort study of women who underwent RSCP between January 2009 and December 2011 at one academic center. The primary outcome was mesh exposure at 6 weeks postoperation. Subjects were divided into two groups: those with concomitant hysterectomy and those with RSCP alone. The hysterectomy group was subdivided into TH versus SCH. Mesh exposures and mesh revision procedures were identified using International Classification of Diseases-9 and CPT codes, respectively, and confirmed by chart review.

Results: There were 230 eligible women who underwent RSCP during the study period and were followed up at a 6-week postoperative visit; 118 (51.7%) had RSCP only and 112 (48.7%) had a concomitant hysterectomy. Of those who underwent hysterectomy, 79 patients (70.5%) had TH and 33 (29.5%) had SCH. There were nine (3.9%) mesh exposures attributed to RSCP. The difference between the RSCP + hysterectomy group and the RSCP-only group was 2.7% versus 5.1% ( P = 0.50). The 2.7% of mesh exposures in the hysterectomy group were associated with TH and none with SCH, but this difference was not significant ( P = 0.55).

Conclusions: Although mesh exposure with RSCP is low, serious morbidity can be associated with mesh use and appropriate preoperative counseling is critical.

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References

1. Wu JM, Hundley AF, Fulton RG, et al. Forecasting the prevalence of pelvic floor disorders in U.S. women: 2010 to 2050. Obstet Gynecol 2009;114: 1278-1283.
 
2. Olsen AL, Smith VJ, Bergstrom JO, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997;89:501-506.
 
3. Nygaard IE, McCreery R, Brubaker L, et al. Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol 2004;104:805-823.
 
4. Siddiqui NY, Geller EJ, Visco AG. Symptomatic and anatomic 1-year outcomes after robotic and abdominal sacrocolpopexy. Am J Obstet Gynecol 2012;206:435.e1-e5.
 
5. Geller EJ, Parnell BA, Dunivan GC. Robotic vs abdominal sacrocolpopexy:44-month pelvic floor outcomes. Urology 2012;79:532-536.
 
6. Geller EJ, Siddiqui NY, Wu JM, et al. Short-term outcomes of robotic sacrocolpopexy compared with abdominal sacrocolpopexy. Obstet Gynecol 2008;112:1201-1206.
 
7. US Food and Drug Administration. UPDATE on serious complications associated with transvaginal placement of surgical mesh for pelvic organ prolapse: FDA safety communication. http://www.fda.gov/medicaldevices/safety/alertsandnotices/ucm262435.htm. Published July 13, 2011. Accessed August 12, 2014.
 
8. Parnell BA, Matthews CA. Robot-assisted techniques and outcomes in the realm of pelvic reconstructive surgery. Clin Obstet Gynecol 2011;54: 412-419.
 
9. Haylen BT, Freeman RM, Swift SE, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS)joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) and grafts in female pelvic floor surgery. Neurourol Urodyn 2011;30:2-12.
 
10. Ganatra AM, Rozet F, Sanchez-Salas R, et al. The current status of laparoscopic sacrocolpopexy: a review. Eur Urol 2009;55:1089-1103.
 
11. Matthews CA, Carroll A, Hill A, et al. Prospective evaluation of surgical outcomes of robot-assisted sacrocolpopexy and sacrocervicopexy for the management of apical pelvic support defects. South Med J 2012;105:274-278.
 
12. Osmundsen BC, Clark A, Goldsmith C, et al. Mesh erosion in robotic sacrocolpopexy. Female Pelvic Med Reconstr Surg 2012;18:86-88.