Mesh Exposure After Laparoscopic Sacrocolpopexy with Concomitant Total Hysterectomy or Uterine Preservation: A Retrospective Cohort Study.

Abstract

<h4>Introduction and hypothesis</h4>Although the role of uterine preservation during open sacrocolpopexy was well-explored, data regarding laparoscopic sacrocolpopexy (LSC) are controversial. This study was aimed at comparing the risk of mesh exposure between LSC with total hysterectomy and the uterine-preserving approach.<h4>Methods</h4>This retrospective cohort study included 198 patients who underwent LSC for pelvic organ prolapse. Based on surgical approach, patients were divided into two groups: those with concomitant total hysterectomy (n = 169) and those who underwent uterus-preserving LSC (n = 29). The primary outcome was mesh exposure. A logistic regression model was employed to calculate odd ratios (OR) and 95% confidence interval (CI) while adjusting potential confounding factors. Secondary outcomes included the composite success, anatomical outcomes, and self-reported symptom improvement.<h4>Results</h4>The median follow-up time of the whole cohort was 32 months. The incidence of mesh exposure was higher in the hysterectomy group compared with the uterine preservation group (27 out of 169, 16.0% vs 1 out of 29, 3.4%, p = 0.13). After controlling confounding factors, concomitant hysterectomy was associated with a nearly tenfold increased risk of mesh exposure (adjusted OR, 9.9; 95% CI, 1.5 to 199.0). There was no statistically significant difference in the composite success endpoint between the two groups (107 out of 131, 81.7% vs 21 out of 25, 84.0%, p = 0.99).<h4>Conclusions</h4>Concomitant hysterectomy during LSC was associated with increased risk of mesh exposure, and the composite success rates of the two groups were similar.