SCP Mesh weight 81 DISCUSSION At a median of 8 years after the index procedure, patients implanted with polypropylene mesh weighing 44g/m2 or more were three times more likely to develop any type of graft-related complications, six times more likely to develop symptomatic graft-related complications, and five times more likely to undergo a reintervention for graft-related complications. Conversely, the vast majority of patients who underwent laparoscopic sacrocolpopexy are (much) improved (PGIC-score 4 or higher), regardless of the type of implant used. Anatomically, recurrence rates at the vault were low and not different between groups. Reinterventions for recurrent apical prolapse were very scarce. Current evidence suggests lighter weight, more porous meshes experimentally induce a milder host response, potentially reducing the risk of complications. This is thought to be due to a lower level of inflammation and the more normal loading on the surrounding tissue, leading to improved tissue in-growth.159 According to a recent narrative review, the overall median exposure rate of SCPmesh is 1.9% (range: 0-13.3%, range of number of patients per study included: 12 to 4,552; range of follow-up 12-72 months).144 That number is lower than in this report (22.8% at a median follow-up of 97 months for heavier-weight mesh and 7.3% at a median of 92.5 months for lightweight mesh). However, the majority of included studies in the narrative review were retrospective and lacked longterm follow-up. Neither were patients systematically clinically assessed. Therefore, asymptomatic exposures might have been underreported, whereas they are included in that part of our cohort that was clinically assessed. Interestingly, the aforementioned review included three observational studies reporting a 0% exposure rate, however at one year after surgery.160-162 This is in line with our findings, confirming neither any symptomatic graft-related complications within the first year after surgery. Conversely, in our study, graft-related complications occurred later on and the incidence increased slowly with time. The same applies to the reinterventions for graft-related complications, also only occurring after 12 months postoperatively (78%). Unfortunately, reinterventions for graft-related complications were not reported in the above review. Our data supports the durability of subjective and anatomical outcomes regardless of the implant used. In other words, the lower rates of graft-related complications and reinterventions for graftrelated complications with lighter mesh are not at the cost of higher apical recurrence rates. Strengths of our study are its prospective data collection, the inclusion of all patients who underwent an operation at a single center, the use of validated questionnaires, and the independent follow-up assessments. We report on mesh related morbidity and additional subjective and
RkJQdWJsaXNoZXIy MTk4NDMw