To mess with mesh? An update on surgery for pelvic organ prolapse

Author(s): C. Ramage - Pages: 21

Abstract

Up to 50% of parous women have some degree of prolapse, which is defined as a hernia of one or more pelvic organs. Women have an 11.1% lifetime risk of needing surgery for prolapse or incontinence. Anterior colporrhaphy was first described in 1913 and is often still the operation of choice, even though there is a 30–43% objective recurrence rate. Better outcome could be achieved by using site-specific ‘selective’ repairs carried out by experienced operators. However, debate continues about the ease of identification of defects and the results of site-specific surgery. Mesh used in surgery provides additional support, the procedures are easy to learn and recurrence rates are lower than with traditional surgery. However, there is limited evidence of improvement in long-term outcomes and complications are potentially greater than with traditional surgery. The National Institute for Health and Clinical Excellence guidelines (NICE 2008) conclude that there is some benefit in using mesh augmentation for anterior prolapse repair, but minimal advantage for posterior prolapse repair. Significant complications include erosion, infection, visceral damage and dyspareunia. Caution
still needs to be exercised in the use of mesh since new advances are unproven as yet, with potentially greater complications and virtually no data on long-term efficacy.

Keywords: mesh, prolapse, surgery.