Evidence to justify retention of transvaginal mesh: comparison between laparoscopic sacral colpopexy and transvaginal Elevate™ mesh

Valerie, To; Hengrasmee, Pattaya; Lam, Alan; Luscombe, Georgina; Lawless, A; Lam, Justin

doi:10.1007/s00192-017-3379-3

Cited by 10 publications

(13 citation statements)

References 26 publications

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“…There were 20 eligible studies, including four RCTs [18][19][20][21][22] (there were two articles 20,21 about one RCT), four prospective studies [23][24][25][26] and 12 restrospective studies, [27][28][29][30][31][32][33][34][35][36][37][38] identified from the MEDLINE, EMBASE, Cochrane Library and clinicaltrials.gov databases. A PRISMA flow diagram depicting the study selection process is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…Four RCTs [18][19][20][21][22] and six NRSIs 23,24,26,28,32,38 were included. A meta-analysis of the reoperation rate showed very-lowquality evidence suggesting no difference between the Figure 3B).…”

Section: Reoperation For Pop Recurrencementioning

confidence: 99%

“…In terms of the operating time, data from four RCTs 18-22 and 12 NRSIs 23,24,26,27,[29][30][31]33,[35][36][37][38] included mean operative duration values (see Supplementary material, Figure S2A) and showed a shorter operative time with TVM surgeries than with SC. Two of the RCTs [20][21][22] lacked values for the standard deviation; hence, the pooled mean difference of operative time was not estimated.…”

Section: Perioperative Complicationsmentioning

confidence: 99%

“…Moderate-quality data favoured no difference between the two procedure types in terms of perioperative haematoma (see Supplementary material, Figure S2B), with pooled odds ratio values of 0.78 (95% CI 0.15-4.07; I 2 = 0%; P = 0.76) for the RCT group and 0.33 (95% CI 0.07-1.60; I 2 = 0%; P = 0.17) for the NRSI group. Regarding estimated blood loss (see Supplementary material, Figure S2C), five NRSIs 24,31,[36][37][38] favoured lower blood loss with SC than with TVM surgery; the pooled mean difference was À60.37 (95% CI À76.01 to À44.72; I 2 = 30%; P < 0.01). For the occurrence of bladder injury (see Supplementary material, Figure S2D), four RCTs [18][19][20][21][22] and 12 NRSIs 23,25,26,28,29,[31][32][33][35][36][37][38] reported pooled odds ratios of 0.68 (95% CI 0.21-2.23; I 2 = 0%; P = 0.52) and 0.98 (95% CI 0.52-1.88; I 2 = 0%; P = 0.96), respectively.…”

Section: Perioperative Complicationsmentioning

confidence: 99%

“…Regarding estimated blood loss (see Supplementary material, Figure S2C), five NRSIs 24,31,[36][37][38] favoured lower blood loss with SC than with TVM surgery; the pooled mean difference was À60.37 (95% CI À76.01 to À44.72; I 2 = 30%; P < 0.01). For the occurrence of bladder injury (see Supplementary material, Figure S2D), four RCTs [18][19][20][21][22] and 12 NRSIs 23,25,26,28,29,[31][32][33][35][36][37][38] reported pooled odds ratios of 0.68 (95% CI 0.21-2.23; I 2 = 0%; P = 0.52) and 0.98 (95% CI 0.52-1.88; I 2 = 0%; P = 0.96), respectively. The pooled odds ratios for bowel injury rates (see Supplementary material, Figure S2E) in three RCTs [19][20][21][22] and nine NRSIs 23,25,26,29,32,33,35,36,38 were 1.63 (95% CI 0.20-13.39; I 2 = 0%; P = 0.65) and 1.28 (95% CI 0.44-3.71; I 2 = 0%; P = 0.68), respectively.…”

Section: Perioperative Complicationsmentioning

confidence: 99%

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Sacrocolpopexy compared with transvaginal mesh surgery: a systematic review and meta‐analysis

Zhang

Sun

Yang

et al. 2020

BJOG

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Background The use of mesh is controversial in the treatment of female pelvic organ prolapse. Objectives To systematically review the outcomes of sacrocolpopexy compared with transvaginal mesh surgery and to provide evidence-based suggestions. Search strategy The MEDLINE, EMBASE, Cochrane Library and clinicaltrials.gov databases were searched on 21 November 2018. Selection criteria Randomised controlled trials and prospective and retrospective cohort studies were included. Data collection and analysis Data were extracted by one reviewer and examined by a second reviewer for accuracy. Odds ratios and 95% CI were calculated using random-effects models. Main results Twenty comparative studies were included. The metaanalysis was performed with subgroups. The summary odds ratios of the randomised controlled group were 1.84 (95% CI 0.79-4.29, I 2 = 75%) for anatomical success, 1.41 (95% CI 0.47-4.24, I 2 = 38%) for subjective success, 0.42 (95% CI 0.18-0.98, I 2 = 0%) for mesh complications, 0.61 (95% CI 0.20-1.91, I 2 = 0%) for prolapse reoperation and 0.44 (95% CI 0.23-0.88, I 2 = 0%) for de novo dyspareunia. The mean differences were 0.77 (95% CI 0.31-1.23, I 2 = 66%) for total vaginal length and À1.28 (95% CI À2.00 to À0.55, I 2 = 66%) for point C after surgery. Conclusions Very-low-quality evidence indicated that the anatomical and subjective success rates of sacrocolpopexy were similar to those of transvaginal mesh surgery; sacrocolpopexy might be more beneficial than transvaginal mesh surgery in terms of mesh-related complication rates, prolapse recurrence and de novo dyspareunia. However, additional high-quality randomised trials with long-term follow-up durations are needed.

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