Abdominal sacral suspensions: Analysis of complications using permanent mesh

Objective This study was undertaken to determine the complication rates of abdominal sacral suspensions (ASC) using polypropylene mesh and to compare the erosion rates in women who underwent ASC at the time of supracervical hysterectomy (SCH) versus total abdominal hysterectomy (TAH) versus ASC in women who had previously undergone TAH. Study design A retrospective analysis of patients from the urogynecology practice at North Shore University Hospital, who underwent ASC with polypropylene mesh between March 1997 and July 2004. Office and hospital charts were reviewed for patient demographics, preoperative history and physical examinations, intraoperative and postoperative findings, and complications. Women were stratified into 3 groups: group I: SCH with ASC; group II: TAH with ASC; and group III: ASC alone in women with a history of prior TAH. Results A total of 121 patients were analyzed and comprised group I, 30.6% (n = 37); group II, 40.5% (n = 49); and group III, 28.9% (n = 35). Four patients (3.3%) had mesh erosions develop. There were no significant differences in age, weight, parity, menopause status, estrogen therapy, previous surgery, or degree of preoperative prolapse between the patients with and without erosions. All the erosions occurred in group II (8.2%, 95% CI (2.3%-19.6%, P = .0389). The intraoperative complication rate was 2.5% and included a cystotomy (n = 2) and a small bowel laceration (n = 1). Immediate postoperative complications included partial SBO/ Ileus (3.5%), febrile morbidity (9.6%), and autologous blood transfusions (1.7%). Long-term complications included persistent vaginal discharge (4.7%), vaginal bleeding (1.6%), dysparuenia (6.3%), and recurrent prolapse (2.5%). There were no significant differences in short- or long-term complications among the 3 groups (P> .05). Conclusion ASC with polypropylene mesh is a safe surgical procedure for vaginal vault prolapse with low complication rates. Mesh erosion occurred in 8.2% of patients who underwent TAH with concurrent ASC. Patients having ASC at the time of TAH had a 7-fold increased risk for mesh erosion compared with patients who underwent SCH with ASC.