Abstract
Objective: To assess the incidence of serious complications and
reoperations for recurrence after pelvic organ prolapse (POP) surgery
and compare the three most common types of repair.
Design: Prospective cohort study using a registry.
Setting: 19 surgical centres in France.
Population: 2309 women participated between 2017 and 2019.
Methods: a multivariate analysis including an inverse probability
of treatment weighting approach was used to obtain three comparable
groups.
Main outcome measures: Serious complications and subsequent
reoperations for POP recurrence
Results: Mean follow-up was 16.6 months. Surgeries included in
the analysis were native tissue vaginal repair (N=504), transvaginal
mesh placement (692), and laparoscopic sacropexy with mesh (1113).
Serious complications occurred among 52 women (2.3%), and reoperation
for recurrence was required for 32 (1.4%). At one year, the cumulative
weighted incidence of serious complications was 1.8% for native tissue
vaginal repair (95% confidence interval 0-3.9), 3.9% for transvaginal
mesh (2.0-5.9), and 2.2% for sacropexy (1.1-2.6). Compared with the
native tissue vaginal repair group, the risk of serious complications
was higher in the transvaginal mesh group (weighted-HR 3.84, 2.43-6.08),
and the sacropexy group (2.48, 1.45-4.23), while the risk of reoperation
for prolapse recurrence was reduced in both groups (transvaginal mesh
[0.22, 0.13-0.39] and sacropexy [0.29, 0.18-0.47]).
Conclusions: Laparoscopic sacropexy with mesh appears to have a
better risk profile (few serious complications and few reoperations for
recurrence) than transvaginal mesh placement (more serious
complications) and native tissue vaginal repair (more reoperations for
recurrence). These results are useful for informing women and for shared
decision making.
Keywords: registry, longitudinal study, mesh, pelvic organ
prolapse, surgical complication.
Tweetable abstract: Laparoscopic sacropexy showed fewer serious
complications than transvaginal mesh and fewer reoperations for
recurrence than vaginal repair.