From the University of Louisville, Louisville, KY.
St Luke's University Health Network, Bethlehem, PA.
Female Pelvic Med Reconstr Surg. 2022 Feb 1;28(2):85-89. doi: 10.1097/SPV.0000000000001087.
This study aimed to compare the incidence of mesh exposure based on route of hysterectomy at the time of minimally invasive sacrocolpopexy. Secondary outcomes included perioperative outcomes and prolapse recurrence.
This was a multicenter, retrospective cohort study. Patients who underwent sacrocolpopexy between 2007 and 2017 were stratified by hysterectomy approach: total vaginal hysterectomy (TVH), total laparoscopic or robotic hysterectomy (TLH), and laparoscopic or robotic supracervical hysterectomy (LSH). Total vaginal hysterectomy was subdivided into vaginal and laparoscopic mesh attachment to the cuff. Statistical analyses were performed, with P < 0.05 denoting statistical significance.
Seven institutions participated, and 502 minimally invasive sacrocolpopexies with concomitant hysterectomy were performed by 23 surgeons: 263 TVH, 128 TLH, and 111 LSH. The median follow-up interval was 10 months, and this was significantly different between the groups (months): TVH, 11 (3-13); TLH, 2 (2-9); and LSH, 12 (5-24; P < 0.01). The overall incidence of vaginal mesh exposure was 4.0% (20/502). There were no significant differences in vaginal mesh exposure based on hysterectomy route: TVH, 5.7% (15/263); TLH, 1.6% (2/128); and LSH, 2.7% (3/111; P = 0.11). Within the TVH group, there was no significant difference in vaginal mesh exposure comparing vaginal and laparoscopic mesh attachment: 1.9% (1/52) versus 6.6% (14/211; P = 0.48). Laparoscopic supracervical hysterectomy demonstrated a significantly higher incidence of recurrence compared with TVH and TLH: 10.8% (12/111) versus 3.4% (9/263) and 2.3% (3/128; P < 0.01).
The incidence of sacrocolpopexy mesh exposure was not significantly different based on route of hysterectomy or mode of mesh attachment to the vagina. There was a significant increase in prolapse recurrence with supracervical hysterectomy.
本研究旨在比较经微创骶骨阴道固定术行子宫切除术时网片暴露的发生率。次要结局包括围手术期结局和脱垂复发。
这是一项多中心、回顾性队列研究。将 2007 年至 2017 年间接受骶骨阴道固定术的患者根据子宫切除术方式进行分层：经阴道全子宫切除术（TVH）、全腹腔镜或机器人辅助子宫切除术（TLH）和腹腔镜或机器人辅助经宫颈子宫切除术（LSH）。经阴道全子宫切除术进一步分为阴道和腹腔镜网片附着于宫颈。进行了统计学分析，P<0.05 表示具有统计学意义。
有 7 家机构参与，由 23 名外科医生完成了 502 例微创骶骨阴道固定术合并子宫切除术：263 例行 TVH，128 例行 TLH，111 例行 LSH。中位随访时间为 10 个月，各组间差异有统计学意义（月）：TVH，11（3-13）；TLH，2（2-9）；LSH，12（5-24；P<0.01）。阴道网片暴露的总发生率为 4.0%（20/502）。基于子宫切除术方式，阴道网片暴露无显著差异：TVH，5.7%（15/263）；TLH，1.6%（2/128）；LSH，2.7%（3/111；P=0.11）。在 TVH 组中，阴道和腹腔镜网片附着在阴道上的阴道网片暴露无显著差异：1.9%（1/52）与 6.6%（14/211；P=0.48）。与 TVH 和 TLH 相比，腹腔镜辅助经宫颈子宫切除术的复发率显著升高：10.8%（12/111）与 3.4%（9/263）和 2.3%（3/128；P<0.01）。
经阴道全子宫切除术、腹腔镜或机器人辅助经宫颈子宫切除术时网片暴露的发生率无显著差异。经宫颈子宫切除术与脱垂复发显著增加相关。
