Efficacy and safety of using mesh or grafts in surgery for anterior and/or posterior vaginal wall prolapse: systematic review and meta‐analysis

Abstract

Background The efficacy and safety of mesh/graft in surgery for anterior or posterior pelvic organ prolapse is uncertain.Objectives To systematically review the efficacy and safety of mesh/graft for anterior or posterior vaginal wall prolapse surgery.Search strategy Electronic databases and conference proceedings were searched, experts and manufacturers contacted, and reference lists of retrieved papers scanned.Selection criteria Randomised controlled trials (RCTs), nonrandomised comparative studies, registries, case series involving at least 50 women, and RCTs published as conference abstracts from 2005 onwards.Data collection and analysis One reviewer screened titles/ abstracts, undertook data extraction, and assessed study quality. Data analysis was conducted for three subgroups: anterior, posterior, and anterior and/or posterior repair (not reported separately).Results Forty-nine studies involving 4569 women treated with mesh/graft were included. Study quality was generally high. Median follow up was 13 months (range 1-51 months). In anterior repair, there was short-term evidence that mesh/graft (any type) significantly reduced objective prolapse recurrence rates compared with no mesh/graft (relative risk 0.48, 95% CI 0.32-0.72). Nonabsorbable synthetic mesh had a significantly lower objective prolapse recurrence rate (8.8%, 48/548) than absorbable synthetic mesh (23.1%, 63/273) and biological graft (17.9%, 186/1041), but a higher erosion rate (10.2%, 68/666) than absorbable synthetic mesh (0.7%, 1/147) and biological graft (6.0%, 35/581). There was insufficient information to compare any of the other outcomes regardless of prolapse type.Conclusions Evidence for most outcomes was too sparse to provide meaningful conclusions. Rigorous long-term RCTs are required to determine the comparative efficacy of using mesh/graft.

Trocar-guided polypropylene mesh for pelvic organ prolapse surgery—perioperative morbidity and short-term outcome of the first 100 patients

“…Additionally, questionnaires were filled in 1 year postoperatively which may affect the reliability of reporting preoperative symptoms. However, the prevalence of persistent subjective symptoms was comparable to a recent review where urinary symptoms were persistently reported by 22.7% patients and bowel symptoms by 4.3% after surgery using a nonabsorbable mesh [22]. Presumably because of persistent or de novo subjective complaints, satisfaction with the operation was reported by 71% of the respondents.…”

Anterior Colporrhaphy Technique and Approach Choices: Turkey Evaluation

“…Ancak aynı zaman periyodunda subjektif/semptomatik rekürrensde fark yoktur (9,23). Son yıllarda Klinik Mükemmellik Enstitüsü Klavuzu'nda kısa dönemde absorbe olmayan meşin kısa dönemde standart cerrahiye göre daha iyi anatomik sonuçları olsa da uzun dönem fayda ve güvenliği ile ilgili iyi kanıt olmadığının bildirilmesi ve FDA tarafından meş ilişkili komplikasyonların nadir olmadığının ve ciddi komplikasyonlara yol açabileceğinin açıklanmasından sonra anterior vajinal duvar prolapsus cerrahisinde meş kullanımı azalma eğilimindedir (11,24). Dünyada doğal dokular ile onarım yönünde eğilim oluşmaya başlamıştır.…”

Optimal repair of pelvic organ prolapse: the debate continues

“…Finally, a meta-analysis encompassing 49 studies and more than 4,500 women determined that nonabsorbable synthetic mesh had a significantly lower objective anterior compartment recurrence rate (8.8%) than either absorbable synthetic mesh (23.1%) or biological graft (17.9%). [32] RCTs comparing outcomes after a mesh kit repair and standard anterior colporrhaphy continue to emerge. Nguyen and Burchette [33] cited a significantly higher anatomic success rate (89%) 12 months after Perigee (AMS Inc., Minnetonka, MN) compared with 55% after anterior colporrhaphy.…”