Mesh-related complications of laparoscopic lateral suspension

Abstract

Objective: Restorative procedures are essential for sexually active vaginal vault prolapse (VVP) cases. There are concerns about the long learning curve and major complications of sacrocolpopexy. Laparoscopic lateral suspension has a relatively short learning curve and no reported major complications. However, there are concerns about the use of mesh in prolapse surgeries and limited data is available about mesh complications with laparoscopic lateral suspension. This study aimed to establish the mesh-related complications after laparoscopic lateral suspension. Study Design: We carried out a retrospective analysis of patients who underwent laparoscopic lateral suspension for symptomatic VVP at three tertiary hospitals. Cases were identified from theatre records with coding data and the universities database. Demographic features, concomitant procedures, duration of surgery, intra-operative complications, hospital stay, change in pelvic organ prolapse quantification point C, Patient Global Impression of Improvement scale records, mesh-related complications and their management are presented. Results: A total of 120 patients underwent laparoscopic lateral suspension for symptomatic vault prolapse between 2014-2019. In total, mesh complications developed in 3 women (2.5%). While two vaginal mesh exposures were successfully managed with topical estrogen, one required surgical excision. One lateral mesh arm was loosened from the skin causing pain and itching. From 110 Patient Global Impression of Improvement scores, 106 women (96%) described their prolapse as ‘very much’ or ‘much’ better, 4 patients (3.6 %) reported ‘no change’ and no one reported worsening of symptoms. Conclusions: This series suggests that laparoscopic lateral suspension has low risk of mesh-related complications. It is a safe and effective procedure for symptomatic vault prolapse with high rates of patient satisfaction.