Compartment-Specific Outcomes of Single-Mesh and Double-Mesh Reinforcement in Laparoscopic Sacrocolpopexy: A Retrospective Cohort Study.

Abstract

<h4>Objective</h4>To compare long-term anatomical, subjective, and surgical outcomes of single-mesh and double-mesh reinforcement for laparoscopic sacrocolpopexy (LSC) by focusing on compartment-specific failure and reoperation.<h4>Design</h4>Retrospective cohort study.<h4>Setting</h4>Single tertiary referral center.<h4>Participants</h4>Women (n = 897) who underwent LSC-based apical prolapse surgery between 2015 and 2024.<h4>Interventions</h4>Patients were classified according to whether single-mesh (anterior-only or posterior-only mesh; n = 560) or double-mesh (anterior and posterior mesh; n = 337) reinforcement was performed during the index surgery.<h4>Results</h4>The primary outcome was time to anatomical failure (AF) in the reinforced compartment (n = 54 patients). Secondary outcomes included AF in nonreinforced compartments, subjective failure (SF), composite failure (CF), reoperation for recurrent prolapse, and mesh-related complications. The AF-free survival rate in the double-mesh group was similar to that in the single-mesh group (92.6% vs. 92.7%; log-rank p = 0.95). The mesh configuration was not associated with AF in the reinforced compartment (adjusted hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.47-1.49). AF in nonreinforced compartments occurred exclusively in the single-mesh group. Firth's penalized Cox regression demonstrated a substantially increased risk of AF in nonreinforced compartments associated with single-mesh reinforcement (adjusted HR, 38.13; 95% CI, 3.70-86,989.61). Reoperation in nonreinforced compartments was limited to the single-mesh group (adjusted HR, 38.23; 95% CI, 3.78-5269.73). CF and SF were more frequent in the single-mesh group. The single-mesh group had a higher risk of SF (adjusted HR, 4.88; 95% CI, 1.19-20.0). Mesh-related complications were infrequent and comparable between groups.<h4>Conclusion</h4>Reinforced compartment durability after LSC was similar between groups. Single-mesh reinforcement was associated with higher risks of failure and reoperation, which led to inferior composite and subjective outcomes without increased mesh-related complications.