SUFU 2021: Mesh Complications After Robotic Sacrocolpopoxey With Concomitant Total Hysterectomy in a Large Retrospective Cohort

( There are reports that concomitant hysterectomy at the time of robotic-assisted abdominal sacrocolpopexy (RASC) increases the rate of mesh erosion by up to 5-fold, with published rates as high as 14%. This rate is thought to be higher after total abdominal hysterectomy (TAH) compared to supracervical hysterectomy (SCH), but with very little long-term follow-up data.

This study sought to determine rates of mesh complications requiring surgery in a large population-based dataset (California Office of Statewide Health Planning and Development) with long-term follow-up. All women undergoing RSC from 01/2012-12/2018 were identified from the datasets with demographics, concomitant procedures, and future procedures for mesh complications collected. Sub-analyses were performed for women with at least 3 years of follow-up, and for cases without a concomitant mid-urethral sling (may account for some cases of mesh extrusion). Of 12,189 women undergoing RSC, 8,723 (72%) had a concomitant hysterectomy. A TAH was performed in 5,352 women (61%), while an SCH was performed in 3,371 women (39%).

222 women (1.8%) required reoperation for mesh complications. The rates of mesh complications requiring reoperation were lower with SCH vs TAH (0.7% vs. 3.2%, p <0.001). In women with at least 3 years of follow-up, the rate of reoperation for mesh complications was 2.1% in the SCH group and 9.0% in the TAH group (p<0.001). Of 6,486 women undergoing RASC and a hysterectomy without concomitant sling, 4,212 and 2,274 underwent TAH and SCH, respectively. The reoperation for mesh complications occurred in 3.5% (n=148) of the TAH cohort and 0.80% (n=18) of the SCH cohort (p <0.001).

The authors concluded that TAH at the time of RASC is associated with a higher rate of reoperation for mesh complications compared to SCH, in both the short and long term. The type of concomitant hysterectomy independently predicts the risk for mesh complications requiring surgery; TAH increases risk, while SCH is protective.

References: Ref: FitzGerald MP, Richter HE, Bradley CS, et al. Pelvic support, pelvic symptoms, and patient satisfaction after colpocleisis. Int Urogynecol J Pelvic Floor Dysfunct. 2008 December; 19(12): 1603-1609.

Presented by: Paige Kuhlmann, Kai Dallas, Alexandra Dubinskaya, Andrew Chen, Victoria Scott, Jennifer Anger, Karyn Eilber, Cedars-Sinai Medical Center

Written by: Diane K. Newman, DNP, CRNP, FAAN, BCB-PMD, Nurse Practioner and Co-Director, Penn Center for Continence and Pelvic Health Adjunct Professor of Urology in Surgery during the 2021 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Winter Meeting.