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Laparoscopic Sacrocolpopexy vs Transvaginal Mesh Repair for Advanced Pelvic Organ Prolapse: 1 Year Results of a Multicenter Randomized Study

Received: 14 March 2020     Accepted: 17 April 2020     Published: 12 May 2020
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Abstract

Backgrounds: Laparoscopic sacrocolpopexy is considered the most durable operation for the repair of advanced uterovaginal prolapse. However, there is still disagreement about whether the efficacy and safety of vaginally implanted mesh to address advanced uterovaginal prolapse is comparable to sacrocolpopexy. Our goal was to evaluate the anatomical and subjective outcomes of laparoscopic sacrocolpopexy versus transvaginal mesh in a randomized trial in China. Methods: A multicenter randomized trial was carried out at 6 tertiary hospitals in China. Patients with symptomatic advanced prolapse (stages III-IV) were enrolled. Between January 2013 and June 2014, a total of 100 women were randomized. 40 laparoscopic sacrocolpopexy procedures and 42 transvaginal mesh procedures were performed. Patients were randomized to undergo either laparoscopic sacrocolpopexy or transvaginal mesh. Results: At 1 year, the anatomic success rate was 92.5% in the laparoscopic sacrocolpopexy arm, compared with 83.3% in the transvaginal mesh group (P=0.35). Laparoscopic sacrocolpopexy was associated with better apical support. The laparoscopic sacrocolpopexy group had a longer operative time. Mesh exposures occurred in 2.5% of laparoscopic repairs vs. 2.4% of transvaginal mesh repairs. Conclusion: In a randomized trial, 1-year objective cure rates were not statistically different. However the success rate was 9.2% higher for laparoscopic sacrocolpopexy. The two procedures had comparable mesh exposure rates, and other complications were rare in both groups. Trial registration: clinicaltrials.gov (NCT01762384). The date of registration was Jan 7th, 2013. URL was https://clinicaltrials.gov/ct2/show/NCT01762384?term=NCT01762384&draw=2&rank=1.

Published in Journal of Gynecology and Obstetrics (Volume 8, Issue 3)
DOI 10.11648/j.jgo.20200803.12
Page(s) 55-61
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Pelvic Organ Prolapse, Laparoscopic Sacrocolpopexy, Transvaginal Mesh

References
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[3] Vergeldt TF, Weemhoff M, IntHout J,, et al. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015; 26: 1559-1573.
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[8] Zhu L. Long-Term Outcomes of the Self-Cut Mesh-Related Modified Total Pelvic Reconstructive Surgical Repair for Pelvic Organ Prolapse in China: A 7-Year Prospective Cohort Study. J Minim Invasive Gynecol. 2015; 22: S252–S253.
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[10] Davila GW, Baessler K, Cosson M, et al. Selection of patients in whom vaginal graft use may be appropriate. Consensus of the 2nd IUGA Grafts Roundtable: optimizing safety and appropriateness of graft use in transvaginal pelvic reconstructive surgery. Int Urogynecol J. 2012; 23 Suppl 1: S7-14.
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[15] Zhu L, Lang J, Sun Z, et al. Pelvic reconstruction with mesh for advanced pelvic organ prolapse: a new economic surgical method. Menopause. 2011; 18: 328-332.
[16] Srikrishna S, Robinson D, Cardozo L. Validation of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse. Int Urogynecol J. 2010; 21: 523-528.
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[18] Shveiky D, Iglesia CB, Sokol AI,, et al. Robotic sacrocolpopexy versus vaginal colpopexy with mesh: choosing the right surgery for anterior and apical prolapse. Female Pelvic Med Reconstr Surg. 2010; 16: 121-127.
[19] Sanses TV, Shahryarinejad A, Molden S, et al; Fellows' Pelvic Research Network. Anatomic outcomes of vaginal mesh procedure (Prolift) compared with uterosacral ligament suspension and abdominal sacrocolpopexy for pelvic organ prolapse: a Fellows' Pelvic Research Network study. Am J Obstet Gynecol. 2009; 201: 519. e1-8.
[20] Bataller E, Ros C, Anglès S, et al. Anatomical Outcomes 1 Year after Pelvic Organ Prolapse Surgery in Patients with and without a Uterus at a High Risk of Recurrence: A Randomised Controlled Trial Comparing Laparoscopic Sacrocolpopexy/Cervicopexy and Anterior Vaginal Mesh. Int Urogynecol J. 2019; 30: 545-555.
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  • APA Style

    Juan Chen, Tao Xu, Xiaowei Zhang, Keqin Hua, Mei Ji, et al. (2020). Laparoscopic Sacrocolpopexy vs Transvaginal Mesh Repair for Advanced Pelvic Organ Prolapse: 1 Year Results of a Multicenter Randomized Study. Journal of Gynecology and Obstetrics, 8(3), 55-61. https://doi.org/10.11648/j.jgo.20200803.12

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    ACS Style

    Juan Chen; Tao Xu; Xiaowei Zhang; Keqin Hua; Mei Ji, et al. Laparoscopic Sacrocolpopexy vs Transvaginal Mesh Repair for Advanced Pelvic Organ Prolapse: 1 Year Results of a Multicenter Randomized Study. J. Gynecol. Obstet. 2020, 8(3), 55-61. doi: 10.11648/j.jgo.20200803.12

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    AMA Style

    Juan Chen, Tao Xu, Xiaowei Zhang, Keqin Hua, Mei Ji, et al. Laparoscopic Sacrocolpopexy vs Transvaginal Mesh Repair for Advanced Pelvic Organ Prolapse: 1 Year Results of a Multicenter Randomized Study. J Gynecol Obstet. 2020;8(3):55-61. doi: 10.11648/j.jgo.20200803.12

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  • @article{10.11648/j.jgo.20200803.12,
      author = {Juan Chen and Tao Xu and Xiaowei Zhang and Keqin Hua and Mei Ji and Luwen Wang and Huicheng Xu and Jinghe Lang and Abraham Morse and Lan Zhu},
      title = {Laparoscopic Sacrocolpopexy vs Transvaginal Mesh Repair for Advanced Pelvic Organ Prolapse: 1 Year Results of a Multicenter Randomized Study},
      journal = {Journal of Gynecology and Obstetrics},
      volume = {8},
      number = {3},
      pages = {55-61},
      doi = {10.11648/j.jgo.20200803.12},
      url = {https://doi.org/10.11648/j.jgo.20200803.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20200803.12},
      abstract = {Backgrounds: Laparoscopic sacrocolpopexy is considered the most durable operation for the repair of advanced uterovaginal prolapse. However, there is still disagreement about whether the efficacy and safety of vaginally implanted mesh to address advanced uterovaginal prolapse is comparable to sacrocolpopexy. Our goal was to evaluate the anatomical and subjective outcomes of laparoscopic sacrocolpopexy versus transvaginal mesh in a randomized trial in China. Methods: A multicenter randomized trial was carried out at 6 tertiary hospitals in China. Patients with symptomatic advanced prolapse (stages III-IV) were enrolled. Between January 2013 and June 2014, a total of 100 women were randomized. 40 laparoscopic sacrocolpopexy procedures and 42 transvaginal mesh procedures were performed. Patients were randomized to undergo either laparoscopic sacrocolpopexy or transvaginal mesh. Results: At 1 year, the anatomic success rate was 92.5% in the laparoscopic sacrocolpopexy arm, compared with 83.3% in the transvaginal mesh group (P=0.35). Laparoscopic sacrocolpopexy was associated with better apical support. The laparoscopic sacrocolpopexy group had a longer operative time. Mesh exposures occurred in 2.5% of laparoscopic repairs vs. 2.4% of transvaginal mesh repairs. Conclusion: In a randomized trial, 1-year objective cure rates were not statistically different. However the success rate was 9.2% higher for laparoscopic sacrocolpopexy. The two procedures had comparable mesh exposure rates, and other complications were rare in both groups. Trial registration: clinicaltrials.gov (NCT01762384). The date of registration was Jan 7th, 2013. URL was https://clinicaltrials.gov/ct2/show/NCT01762384?term=NCT01762384&draw=2&rank=1.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - Laparoscopic Sacrocolpopexy vs Transvaginal Mesh Repair for Advanced Pelvic Organ Prolapse: 1 Year Results of a Multicenter Randomized Study
    AU  - Juan Chen
    AU  - Tao Xu
    AU  - Xiaowei Zhang
    AU  - Keqin Hua
    AU  - Mei Ji
    AU  - Luwen Wang
    AU  - Huicheng Xu
    AU  - Jinghe Lang
    AU  - Abraham Morse
    AU  - Lan Zhu
    Y1  - 2020/05/12
    PY  - 2020
    N1  - https://doi.org/10.11648/j.jgo.20200803.12
    DO  - 10.11648/j.jgo.20200803.12
    T2  - Journal of Gynecology and Obstetrics
    JF  - Journal of Gynecology and Obstetrics
    JO  - Journal of Gynecology and Obstetrics
    SP  - 55
    EP  - 61
    PB  - Science Publishing Group
    SN  - 2376-7820
    UR  - https://doi.org/10.11648/j.jgo.20200803.12
    AB  - Backgrounds: Laparoscopic sacrocolpopexy is considered the most durable operation for the repair of advanced uterovaginal prolapse. However, there is still disagreement about whether the efficacy and safety of vaginally implanted mesh to address advanced uterovaginal prolapse is comparable to sacrocolpopexy. Our goal was to evaluate the anatomical and subjective outcomes of laparoscopic sacrocolpopexy versus transvaginal mesh in a randomized trial in China. Methods: A multicenter randomized trial was carried out at 6 tertiary hospitals in China. Patients with symptomatic advanced prolapse (stages III-IV) were enrolled. Between January 2013 and June 2014, a total of 100 women were randomized. 40 laparoscopic sacrocolpopexy procedures and 42 transvaginal mesh procedures were performed. Patients were randomized to undergo either laparoscopic sacrocolpopexy or transvaginal mesh. Results: At 1 year, the anatomic success rate was 92.5% in the laparoscopic sacrocolpopexy arm, compared with 83.3% in the transvaginal mesh group (P=0.35). Laparoscopic sacrocolpopexy was associated with better apical support. The laparoscopic sacrocolpopexy group had a longer operative time. Mesh exposures occurred in 2.5% of laparoscopic repairs vs. 2.4% of transvaginal mesh repairs. Conclusion: In a randomized trial, 1-year objective cure rates were not statistically different. However the success rate was 9.2% higher for laparoscopic sacrocolpopexy. The two procedures had comparable mesh exposure rates, and other complications were rare in both groups. Trial registration: clinicaltrials.gov (NCT01762384). The date of registration was Jan 7th, 2013. URL was https://clinicaltrials.gov/ct2/show/NCT01762384?term=NCT01762384&draw=2&rank=1.
    VL  - 8
    IS  - 3
    ER  - 

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Author Information
  • Department of Obstetrics/Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China

  • Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China

  • Department of Gynecology, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China

  • Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China

  • Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

  • Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University and Henan Province Maternal and Child Health Care Hospital, Zhengzhou, China

  • Department of Gynecology, Southwest Hospital of the Third Military Medical University, Chongqing, China

  • Department of Obstetrics/Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China

  • Department of Gynecology, Guangzhou Women and Children’ Medical Center, Guangzhou, China

  • Department of Obstetrics/Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China

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