Vaginal Mesh an Option for Second Prolapse Surgery

Since scar tissue can provide defense versus mesh erosion, women who require reoperation for persistent prolapse may gain from vaginal mesh repair work, new research study programs.

This is very important details to have “when you are counseling women whether they must get the mesh,” stated Nicholas Bongos, MBChB, from Saint Peter’s University Healthcare facility in New Brunswick, New Jersey.

Females should be counseled to attempt primary repair work. If that doesn’t work, harmonize may be a reasonable choice, he informed Medscape Medical News.

Dr. Kongoasa provided the research here at the American Congress of Obstetricians and Gynecologists (ACOG) 2014 Annual Scientific Fulfilling.

The retrospective case– control research included 810 cases of mesh-augmented pelvic floor repair service in 518 patients from June 2008 to December 2011. A case was identified by the variety of pieces of mesh put; a client who received a combined anterior and posterior repair service with mesh in both compartments counted as 2 cases.

All surgeries were carried out by the exact same surgeon using an uniform surgical strategy and the same synthetic mesh material. Mesh disintegration was specified as any direct exposure of mesh on visual assessment of the vagina.

Postoperative follow-up continued till December 2012, and varied from 12 to 54 months.

“The conclusion was in fact the reverse of exactly what I anticipated,” reported Dr. Kongoasa.

Scar tissue might protect versus mesh disintegration due to the fact that of a reduced blood supply, which would equate into decreased bleeding and, potentially, decreased reaction to the international mesh body, he recommended.

According to Dr. Kongasa, roughly one-third of women experience vaginal prolapse, and 3 % of them have 2 or more surgeries to deal with prolapse. The high incidence of first surgical treatment failure has actually caused physicians to check out making use of different products to enhance repair.

Using mesh has resulted in a lower reoccurrence of prolapse; nevertheless, mesh surgeries have a high problem rate (10 %), 70 % of which need medical revision.

This research is the very first to compare vaginal mesh disintegration in clients who have gone through previous prolapse surgical treatment and those who have not.

“This research goes along with exactly what ACOG has actually been saying,” Dr. Kongoasa stated. Vaginal mesh repair service should be reserved for high-risk people, such as those with recurrent prolapse, according to recommendations released by the ACOG and the American Urogynecologic Society.

 

Limitations to this study include its retrospective nature, the presence of confounding variables, and loss to follow-up.

“The important thing to emphasize about this research study,” stated Caela Miller, MD, from the San Antonio Military Medical Center, is its retrospective nature. None of these ladies were dealt with after 2011, so “no new ladies got mesh,” she informed Medscape Medical News. Dr. Miller is a member of the ACOG Committee on Scientific Program.