Mesh-Related Complications of Sacrocervicopexy with Supracervical Hysterectomy

Objectives: Minimally invasive sacrocolpopexy (MISC) combined with hysterectomy has emerged as the preferred surgical approach for treatment of uterovaginal prolapse, surpassing the traditional open approach. However, technical aspects are not standardized, leading to variations in techniques, suture and mesh materials, and type of surgeon performing the surgery.

The objective of this study was to investigate mesh-related complications in women undergoing sacrocolpopexy with concurrent supracervical hysterectomy exploring differences in surgical techniques and materials.

Methods: This is an analysis of a large retrospective cohort from multiple academic and non-academic centers. Patients with MISC and concurrent supracervical hysterectomy (SCH) between May 2007 and December 2021were included. The charts were reviewed for demographics, perioperative characteristics, and postoperative outcomes. Mesh complications were defined as vaginal mesh exposure or erosion into viscera and were identified using CPT codes and chart review. Patients were excluded if there was no operative report or postoperative exam available. Parametric and non-parametric tests were used as appropriate to determine differences in patient and surgical factors between surgery type and complication occurrence; p values ≤ 0.05.

Results: A total of 603 patients were included in this analysis with mean follow-up of 55 months. Majority of MISC were laparoscopic (87%), with 53% performed by minimally invasive gynecologic surgeons (MIGS). Majority of patients undergoing surgery were postmenopausal (69%). Mesh exposure occurred in 7 out of 603 patients (1.2%). 6 out of 7 cases with mesh exposure (p < 0.001) utilized multifilament braided permanent suture for vaginal mesh attachment. There was no visceral mesh erosion observed. There was no significant difference observed among patients with mesh exposure in relation to smoking status, menopausal status, perioperative estrogen use, primary energy instrumentation, or weight of mesh (Table 1).

Conclusions: Mesh-related complications after MISC with concurrent SCH are rare. Use of permanent multifilament braided suture for vaginal mesh attachment may increase the risk of vaginal mesh exposure. All mesh-related complications occurred in surgeries performed by MIGS surgeons. This study is one of few large-scale investigations utilizing both CPT codes and extensive chart review methodologies. It sheds light on the nuanced impact of sutures and surgeon specialization on patient outcomes. Further research is imperative to elucidate the precise influence of surgical techniques and materials on patient outcomes during concurrent hysterectomy and MISC procedures.