CESA/VASA 61 validated Pelvic Organ Prolapse Quantification (POP-Q) scoring system52 for staging the degree of pelvic organ prolapse. Restoration of apical vaginal support was achieved in 97-100% of participants at 4 to 6 months follow-up. The details are presented in Table 4. In one case series of 120 women, four had a relapse of apical prolapse within 2 months of surgery because the fixation of the cervix with absorbable suture material was released by itself. These women underwent subsequent laparoscopy with refixation at the cervix using non-absorbable sutures to restore the anatomy.37 Further reintervention rates for prolapse were reported in four studies37,110,123,124 and ranged between 0% (0/10)123 and 7% (5/76)110. Overall, 13/299 (4.4%) participants underwent further prolapse repair within 12 months of the index procedure. One case series reported on an additional 8/93 (8.6%) women with further symptomatic prolapse (6 anterior, 2 posterior), but who were not re-operated.124 Certainty assessment of the four studies reporting prolapse led to a low level of evidence. Safety Six studies, documenting 487 interventions, described intra-operative complications.37,106,107,110,123,124 Damage to the sacral pelvic veins, severe bleeding and haematoma were reported in six cases (1.2%). In most cases, bleeding was managed with pressure and haemostatic sealants, after which the procedure was abandoned. In one patient assistance from a vascular surgeon and packing was needed.124 Whether transfusions were required was not reported. There was one reported case of intraoperative damage to the sigmoid colon and one bladder injury.37 Five studies, representing 395 interventions, reported postoperative complications.37,106,110,123,124 Postoperative bowel problems were reported in two studies.37,124 One patient needed a second look laparoscopy for obstruction: bowel adhesions were released and she recovered.124 Constipation was reported by 14% of patients at 1-year follow-up in the same case series of 93 women.124 A second case series reports 0% (0/120) of patients having symptoms of obstructive defaecation postoperatively.37 Four (4/103) cases of postoperative wound infections were reported.123,124 Urethral pain was reported in 1 patient in the case series of 93 women.124 The occurrence of graft related complications was reported in 344 participants in four studies.37,106,110,124 One patient had an exposure; a segment of the mesh was removed under general anaesthesia and symptoms resolved.
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