SCP Mesh weight 71 ABSTRACT Objective: To estimate the long-term incidence and characteristics of graft-related complications, rate of reintervention for graft-related complications and prolapse, and subjective and anatomical outcomes after laparoscopic sacrocolpopexy with heavier-weight (more than 44 g/m²) compared with lightweight (28 g/m²) polypropylene mesh, the latter with resorbable poliglecaprone component. Methods: We conducted a single-center study that compared two consecutive prospective cohorts of patients who were undergoing laparoscopic sacrocolpopexy for symptomatic stage 2 or greater cervical or vault prolapse, by using either heavier-weight-polypropylene or lightweight polypropylene mesh at similar duration of follow-up. The primary outcome was the occurrence of graft-related complications and their nature. Secondary outcomes included reinterventions for graftrelated complications, recurrent apical prolapse, a subjective (PGIC [Patient Global Impression of Change-score] 4 or higher), and an anatomical outcome (C -1cm or greater). Results: We identified consecutive patients, 101 were implanted with heavier-weight polypropylene, and 238 with lightweight polypropylene, all audited at comparable follow-up (heavier weight: 97 months [interquartile range 16 months] and lightweight: 92.5 months [interquartile range 58 months]). Graft-related complications were more frequent in patients with heavier-weight than lightweight mesh (22.8% [23/101] vs. 7.3% [13/178]; hazard ratio [HR] 3.3; 95%-CI 1.6-7.1), more frequently symptomatic (heavier-weight mesh: 16.8% [17/101] vs. lightweight: 2.8% [5/178]; HR 6.0, 95% CI 2.5-14.3), and more frequently leading to reintervention for graft-related complications (heavier-weight mesh: 18.8% [19/101] vs lightweight mesh: 2.1%[5/238]; HR 4.6; 95% CI 1.9-11.2). The vast majority of patients were improved (PGIC score 4 or higher), without difference between groups (heavier-weight mesh: 71/84 [84.9%]; lightweight mesh: 154/178 [86.5%]; HR 0.8; 95% CI 0.6-1.1), neither was there a difference in anatomical failure rate (heavier-weight mesh: 1/60 [1.7%] vs lightweight mesh:8/131 [6.1%]; HR 0.3; 95% CI 0.1-1.4). Reoperations for recurrent vault prolapse were scarce (0.0% in heavier-weight mesh, vs 0.4% in lightweight mesh). Conclusions: In two consecutive cohorts, the number of graft-related complications, symptomatic graft-related complications and reinterventions for graft-related complications were higher in patients implanted with heavier-weight polypropylene than when lightweight polypropylene was used. There were no differences in subjective, objective outcomes and reoperation rates for prolapse. Clinical Trial Registration: ClinicalTrials.gov, NCT04378400. Funding: To assist in this audit the University Hospitals Leuven received support from Ethicon Endosurgery. Under that agreement, the investigators designed the protocols, are owners of the results and have the right to publish these independently of the above.
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