Premium
OP13.09: Hiatal ballooning is an independent risk factor of prolapse recurrence
Author(s) -
Rodrigo N.,
Shek K.,
Wong V.,
Dietz H. P.
Publication year - 2012
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.11519
Subject(s) - medicine , avulsion , symphysis , surgery , parametrium , ultrasound , hymen , radiology , vagina , cervix , cancer
Global failure: Cystocele with high mobility of cranial and caudal mesh aspects on Valsalva. Results: We saw 301 patients ≥ 3 months after AC + mesh. 5 were excluded because of missing data, leaving 296. Mean follow-up was 1.8 years (0.3–5.6). 139 had a Perigee, 66 an Anterior Prolift, 91 an Anterior Elevate. 242 (82%) were satisfied with the outcome, 275 (93%) considered themselves cured/improved. Recurrent prolapse symptoms were reported in 65 (22%). Recurrent cystocele was noted in 128 (43%) clinically and 105 (35%) on US. Mean Ba was −1.6 (−3 to +2). Mean cystocele descent was 5.1 mm below the pubis (+ 21.8 to −44 mm). Avulsion was diagnosed in 117 patients (39.5%). Mean hiatal area on Valsalva was 33.3 cm2. Mesh failure was diagnosed in 112 (38%); global in 81, apical in 23 and anterior in 8. Cystocele recurrence was associated with hiatal area (P < 0.001) and avulsion (P = 0.017). Apical and global mesh failure were also significantly associated with these parameters, but this was not the case for anterior failure. Conclusions: We documented mesh failure after AC + mesh in 38% at a mean of 1.8 years. Most were global or apical failures, implying dislodgment of lateral and/or apical anchors or fixation, and associated with hiatal area. It is plausible that a larger hiatus subjects anchoring structures to greater loads, increasing recurrence risk. Future studies should focus on improving implant design.