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A comparison of two different mesh kit systems for anterior compartment prolapse repair
Author(s) -
Wong Vivien,
Shek Ka Lai,
Rane Ajay,
Lee Joseph,
Rosamilia Anna,
Dietz Hans Peter
Publication year - 2014
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.12194
Subject(s) - medicine , surgery , symphysis , surgical mesh , hernia
Background and Aim Mesh reinforcement is considered an effective method for anterior compartment prolapse repair. Two common methods of mesh reinforcement involve either transobturator fixation (eg P erigee™) or lateral and apical anchoring (eg A nterior E levate™). The aim of this study was to assess subjective and objective outcomes after Anterior Elevate and Perigee mesh kit surgery. Materials and Methods This was a surgical audit of patients after anterior colporrhaphy ( AC ) with mesh reinforcement, undertaken at three tertiary urogynaecological centres. All patients were assessed for prolapse recurrence, which was defined as either (i) symptoms of prolapse (vaginal lump/dragging), (ii) ICS POPQ ≥ Stage 2, or (iii) bladder descent ≥10 mm below the symphysis pubis on transperineal ultrasound. Mesh co‐ordinates and organ descent on Valsalva were determined relative to the inferior symphyseal margin. Results Two hundred and twenty‐nine patients with anterior compartment mesh (138 P erigee, 91 E levate) were assessed at a median follow‐up of 1.09 years ( IQR 0.65–2.01). On assessment, 24% ( n = 55) had symptoms of prolapse recurrence, 46% ( n = 106) had a clinical recurrence, and 41% ( n = 95) a recurrent cystocele sonographically. All objective results favoured the P erigee group. The superiority of the Perigee kit remained highly significant ( P < 0.0001 for all clinical and ultrasound measures of prolapse recurrence) on multivariate analysis. Conclusions This retrospective analysis suggests that apical anchoring such as A nterior E levate mesh system does not necessarily confer an advantage over the original transobturator mesh fixation technique for anterior compartment reconstruction.