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Determinants of Dissatisfaction After Laparoscopic Cure of Vaginal and/or Rectal Prolapse using Mesh: a Comprehensive Retrospective Cohort Study

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Abstract

Introduction and Hypothesis

The primary objective is to identify determinants of dissatisfaction after surgical treatment of vaginal prolapse ± rectal prolapse, using laparoscopic mesh sacrohysteropexy (LSH) or sacrocolpopexy (LSC) ± ventral mesh rectopexy (VMR). The secondary objective is the evaluation of complications and objective/subjective recurrence rates.

Methods

The study performed was a single-surgeon retrospective review of prospectively collected data. LSH/LSC ± VMR were performed between July 2005 and September 2022. Primary investigated outcome was patients’ satisfaction, assessed using the Patient Global Impression of Improvement (PGI-I) score and the bother visual analog scale (VAS) obtained postoperatively (at a 1-month interval and on a 6-month/yearly basis thereafter). We looked for a correlation between the level of satisfaction (as reflected by the VAS) and potential determinants.

Results

There were 355 patients with a mean age of 62 ±12 years. Nearly all the patients (94.3%) had a stage 3 or 4 prolapse according to the POP-Q classification. The mean postoperative bother VAS was 1.8, with only 12.7% of patients reporting a bother VAS score ≥ 3/10, indicating a dissatisfaction. PGI-I showed improvement in the vast majority of patients (96.4% scoring 1 to 3). Patients with anal incontinence preoperatively scored higher on the bother VAS postoperatively (r=0.175, p < 0.05). The use of a posterior arm mesh (for posterior vaginal prolapse) correlated with better satisfaction overall (r= −0.178, p = 0.001), whereas the performance of VMR was associated with a bothering sensation (r = 0.232, p < 0.001). A regression analysis confirmed the impact of posterior mesh and VMR on satisfaction levels, with odds of dissatisfaction being 2.18 higher when VMR was combined with LSH/LSC.

Conclusions

Posterior mesh use improves patient satisfaction when the posterior compartment is affected. In patients with concomitant vaginal and rectal prolapse, combining VMR with anterior LSC/LSH appears to negatively impact patients’ satisfaction. Preoperative anal incontinence was demonstrated to be a risk factor for postoperative dissatisfaction.

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Authors and Affiliations

  1. Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France

    Wissam Arab, David Lukanović, Mija Blaganje & Bruno Deval

  2. Department of Gynecology, Division of Gynecology and Obstetrics, Ljubljana University Medical Center, Ljubljana, Slovenia

    David Lukanović & Mija Blaganje

  3. Department of Gynecology and Obstetrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

    David Lukanović & Mija Blaganje

  4. Department of Education Studies, Faculty of Education, University of Ljubljana, Ljubljana, Slovenia

    Miha Matjašič

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  1. Wissam Arab
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  2. David Lukanović
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  3. Miha Matjašič
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  4. Mija Blaganje
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  5. Bruno Deval
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Contributions

W.A.: data collection, manuscript writing; D.L.: data collection, manuscript writing; M.M.: statistical data processing; M.B.: manuscript review and editing; B.D.: project development, manuscript review and editing.

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Correspondence to Bruno Deval.

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Arab, W., Lukanović, D., Matjašič, M. et al. Determinants of Dissatisfaction After Laparoscopic Cure of Vaginal and/or Rectal Prolapse using Mesh: a Comprehensive Retrospective Cohort Study. Int Urogynecol J 35, 457–465 (2024). https://doi.org/10.1007/s00192-023-05701-3

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