Hypothesis / aims of study
Laparoscopic pectopexy is considered an alternative to laparoscopic sacropexy for the treatment of pelvic organ prolapse, with subtotal hysterectomy often performed prior to pectopexy in previous studies (1). Additionally, various meshes have been used across different studies (2). However, the effectiveness of pectopexy with different meshes for uterine preservation remains unclear. Therefore, we compared the one-year outcomes of two approaches: inverted T polypropylene mesh and polyvinylidene difluoride (PVDF) mesh.
Study design, materials and methods
This retrospective cohort study examined patients diagnosed with genital prolapse who underwent laparoscopic pectopexy with uterine preservation at two medical centers. A total of 83 out of 85 women (97.6%) with pelvic organ prolapse (POP) ≥ Stage II were included in the study. Participants were treated with either inverted T polypropylene mesh (group 1, n = 41) or PVDF mesh (group 2, n = 42). The inverted T polypropylene mesh group used the APIS Pelvi-Stop Mesh (PS-8) to cover the anterior compartment for apical and anterior vaginal suspension, while the PVDF mesh group utilized DynaMesh for apical suspension (Figure 1), with the option for additional anterior or posterior repair transvaginally, if necessary. Data were analyzed using SPSS to evaluate baseline characteristics, perioperative complications, surgical outcomes at the 1-year follow-up, and POP-Q assessment results.
Results
The patient characteristics were similar between the two groups, including mean age, body mass index, and menopause status (Table 1). The rates of concomitant surgeries, such as trachelectomy and mid-urethral sling procedures, were comparable between the groups. However, a higher proportion of patients in the PVDF mesh group underwent anterior colporrhaphy (90.47% vs. 17.07%, p = 0.001) and posterior colporrhaphy (76.19% vs. 43.90%, p = 0.004).
Compared to the inverted T polypropylene mesh group, the PVDF mesh group had a shorter hospital stay (4.57 days vs. 5.2 days, p = 0.001), a shorter Foley drainage duration (2.4 days vs. 3.8 days, p < 0.001), less blood loss (32.26 mL vs. 66.34 mL, p = 0.031), and lower post-operative pain scores (1.98 vs. 2.34, p = 0.025).
Surgical effectiveness at one year, including pelvic organ prolapse (≤ stage 1) (78.05% vs. 80.95%, p = 0.791) and cure of stress urinary incontinence (100.0% vs. 90.9%, p = 0.492), showed no significant differences between the groups. Additionally, there were no significant differences in surgical complications, with only one case of delayed free voiding (>7 days) and one case of vaginal mesh extrusion observed in the inverted T polypropylene mesh group.
Interpretation of results
This is the first comparison of the surgical effectiveness of different meshes in laparoscopic pectopexy. We found that the inverted T polypropylene mesh group demonstrated comparable surgical effectiveness to the PVDF mesh group, with both achieving approximately 80% success. The PVDF mesh group had a shorter surgical time, as the anterior and posterior repairs were converted to vaginal procedures, which are less time-consuming. Apical recurrence was the primary concern, as pectopexy provides only lateral suspension. This may result in inadequate apical support when the uterus is preserved, leading to some cases of failure.