Long-term complications and reoperation after laparoscopic apical mesh fixation: sacrocolpopexy and sacrohysteropexy.

Abstract

<h4>Objectives</h4>This study aimed to evaluate pelvic organ prolapse (POP) recurrence that required reoperation, mesh-related complications that required reoperation, and stress urinary incontinence (SUI) that required mid-urethral sling (MUS) surgery. It also aimed to identify risk factors for reoperation after laparoscopic sacrocolpopexy (SCP).<h4>Methods</h4>We retrospectively analyzed 484 patients with symptomatic POP who underwent SCP at a single institution between 2015 and 2021. Data regarding POP severity and surgical techniques were collected. A Cox regression analysis was performed to assess associations between potential risk factors and reoperation for POP recurrence. Complications classified as grade III based on the Clavien-Dindo classification, such as POP recurrence, mesh-related complications, and SUI, were the primary outcomes.<h4>Results</h4>The mean age at the time of SCP was 71.6 years (±7.4 years). All patients had stage III or worse POP according to the POP quantification (POP-Q) classification. The median follow-up duration was 46.0 months (interquartile range, 25.0-59.0). The overall reoperation rate was 15.3 %. The MUS procedure for SUI was the most common reoperation (7.4 %), followed by reoperation for POP recurrence (5.2 %) and reoperation for mesh-related complications (3.5 %). The Cox regression analysis revealed that a higher body mass index at the time of the initial surgery was significantly associated with an increased risk of reoperation for POP recurrence (hazard ratio, 1.136; 95 % confidence interval, 1.012-1.276).<h4>Conclusion</h4>Approximately one in seven patients required reoperation after SCP. These findings may enhance preoperative counseling and support more informed decision-making.