ABDOMINAL SACRAL SUSPENSIONS: ANALYSIS OF COMPLICATIONS USING PERMANENT MESH

G. Bensinger, L. Lind, M. Guess, A. Winkler

Centennial Women’s Center, Bronx, NY

OBJECTIVE:  To examine the complication rates of abdominal sacral suspensions

(ASSs) using polypropylene mesh and to compare erosion rates in women who underwent ASSs with concomitant supracervical hysterectomy (SCH) versus total abdominal hysterectomy (TAH) versus delayed ASSs in women who had previously undergone total abdominal hysterectomy.

MATERIALS AND METHODS:  A retrospective analysis of patients from the Urogynecology practice at North Shore University Hospital, who underwent ASSs with polypropylene mesh between March 1997 and February 2004.  Office and hospital charts were reviewed for patient demographics, pre-operative history and physical examinations, intra-operative and post-operative findings and complications.  Women were stratified into three groups:  Group I: SCH with concurrent ASS; Group II: TAH with concurrent ASS; Group III:  ASS alone in women that had undergone a TAH during a previous operation.  In all cases, polypropylene mesh was attached anteriorly to the pubo-cervical fascia and posteriorly to the recto-vaginal fascia with symmetric broad base attachments.  Patients were seen for follow up post-operatively at 3 weeks, 3 months, and 6 months.  Categorical variables were compared using the Fisher exact test with 95% confidence intervals.   Continuous variables were compared using the Mann-Whitney test. 

RESULTS:  Data from one hundred and two patients were analyzed: Group I, 23.5 % (n=24); Group II, 46.1 % (n = 47); Group III, 30.4% (n=31).  The mean age and weight were 53 ± 10.36 and 149 ± 26.79, respectively.  Five patients (4.9%) experienced mesh erosions.  There were no significant differences in age, weight, parity, menopause status, estrogen therapy, previous surgery, or degree of pre-operative prolapse between the patients with and without erosions.   All of the erosions occurred in group II (10.6%, 95% C.I. (3.5%-23.1%), however this difference did not reach statistical significance (p=.0839). Four of the five erosions were cured with outpatient management; one erosion necessitated revision in the operating room.  The intra-operative complication rate was 2% and included a cystotomy (n =1) and a superficial bowel laceration (n =1).  Immediate post-operative complications included partial SBO/ Ileus (4%), febrile morbidity (8%), and autologous blood transfusions (2%).  Long-term complications included persistent vaginal discharge (8%), vaginal bleeding (2%), dyspareunia (9%), and recurrent prolapse (2%).  There were no significant differences in short or long-term complications between the three groups (p > .05).

CONCLUSIONS:  ASS with polypropylene mesh is a safe surgical therapy for vaginal vault prolapse with overall low complication rates.  An erosion rate of 10.6% occurred in patients who underwent TAH with concurrent ASS.  Although statistical inference was limited by sample size, this paper supports previous literature findings in suggesting a lower likelihood of erosion when performing ASS with SCH versus TAH.  Consideration should be given for cervical conservation to reduce this complication.

Disclosure – Consultant: L. Lind, AMS, Pfizer, Gynecare, Boston Scientific, Ortho-McNeil, Watson; A. Winkler, AMS, Pfizer, Gynecare, Boston Scientific, Ortho-McNeil, Watson; Speakers Bureau: M. Guess,  AMS, Sanctura.