Chapter 4.2.1 72 INTRODUCTION Sacrocolpopexy is the gold standard for apical prolapse repair.104 This procedure involves the use of a mesh to suspend the vaginal vault to the promontory. This foreign body can cause graft-related complications, which may be difficult to treat.33 One of the claimed factors for the occurrence of graftrelated complications, is the nature of the implant used. Heavy, rather than light materials have been shown to induce a stronger inflammatory response and more bridging fibrosis, both experimentally 135-140 as well as in clinical explants.141 The optimal balance between weight and pore geometry remains unclear.142,143 Experimental and pathology findings are only clinically relevant if they translate into improved patient outcomes. For instance, one claim is that lightweight meshes induce less exposures than heavier-weight grafts, yet potentially at the expense of higher recurrence rates.144-146 Clinical data to support this are scarce with few head-to-head comparisons for the same procedure yet with different materials, including laparoscopic sacrocolpopexy.147 The American College of Obstetricians and Gynecologists, the European Urogynaecology Association, the American Urogynecologic Society, the International Federation of Gynecology and Obstetrics, and regulators (SCENIHR [The Scientific Committee on Emerging and Newly Identified Health Risks]) have recommended the use of lighter products.148,149,150 In January 2007, we also moved from heavier-weight polypropylene implants (Marlex, Gynemesh and Prolene) to the lighter polypropylene products (28 g/m², strengthened with resorbable poliglecaprone fibers; marketed as Ultrapro and Artisyn). This created an opportunity to compare two consecutive, hence unselected cohorts of patients undergoing laparoscopic sacrocolpopexy with heavier-weight and lightweight polypropylene mesh.135,139 MATERIALS AND METHODS This study is part of an ongoing institutional audit of a prospective cohort,28,151,152 that includes all consecutive patients undergoing laparoscopic sacrocolpopexy for symptomatic stage 2 or greater uterine or vault prolapse. Surgery was performed or supervised by a senior consultant urogynecologist using a standardized technique and a structured training program, as earlier described.30,152,153 Herein, we compare outcomes of two nonparallel, consecutive cohorts at similar duration of follow up, including participants implanted with 101 heavier-weight implants previously reported on31 and 238 participants implanted with lighter implants. Over time, marketed implants became progressively lighter in weight, but all contained durable polypropylene fibers (Table 1).
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