Comparison of Two Levels of Mesh Fixation to the Anterior Vaginal Wall During Sacrocolpopexy

Abstract

Background: Vaginal surgery was the traditional way to manage uterovaginal prolapse. However, it has a high rate of recurrence. Aims: this study aimed to compare the outcomes of abdominal hysterectomy and sacrocolpopexy using short and long vaginal mesh arms in women with uterovaginal prolapse. Patients and Methods: We conducted a retrospective cohort study of women with uterovaginal prolapse. The study included 185 patients. The patients were divided into two groups. Each patient underwent abdominal hysterectomy and sacrocolpopexy. Sacrocolpopexy was done using a Y-shaped polypropylene mesh. The posterior arm was fixed to the posterior vaginal wall down to the level of the levator ani. The anterior arm was fixed to the anterior vaginal wall to a variable distance of 2 to 3 cm in the short arms group or down to the trigone in the long arms group. Results: The use of long arms mesh was associated with significantly lower rate of recurrence. Eighty percent of recurrence occurs in the short arm group. In comparison, 20% of recurrence occurs in the long arm group. There was no repeat surgery in the long arms group compared with 4% in the short arms group. Conclusion: In women with uterovaginal prolapse, abdominal hysterectomy and sacrocolpopexy using long vaginal mesh arms appears to result in a lower rate of recurrence compared to abdominal hysterectomy and sacrocolpopexy using short vaginal mesh arms.

Keywords

• hysterectomy; mesh; sacrocolpopexy