Redo SCP 95 DISCUSSION In our experience, the intraoperative and early postoperative complication rates of redo LSCP were comparable to that of primary procedures, yet there were more conversions. There were no statistically significant differences in the rate of GRC or reinterventions for complications, prolapse or urinary incontinence. At a median of more than five years, subjective and objective outcomes were also comparable. Our findings are consistent with those of a recent cohort study on redo LSCP by Panico, apart from a higher perioperative complication rate (21.1% vs 5.0%).173 In the former study, the single reported complication was a urinary infection. Comparison to that study is difficult as only complications occurring within one rather than three months were considered. Both studies did not report any severe (grade III or IV) complications. Obviously, the total number of redo procedures (n=59) available remains limited, hence too small to detect rare events. We acknowledge that the perioperative complication rate is higher than what is typically reported in literature.168,175,179 This is in both groups and mainly due to a high rate of early postoperative complications (redo: 20.5%, control: 25.0%). They are typically infectious Dindo grade II, hence minor, complications with little clinical relevance as they are treated by a single course of antibiotics (redo: 7/11 [63.6%] vs control: 28/41 [68.3%]). All but one conversions in our redo group were reactive because of adhesions, which is obviously more likely after previous LSCP. Conversely, the median duration of adhesiolysis in redo procedures was short (5 minutes) and comparable to that of primary procedures (4 minutes), thus the decision to convert was probably always taken early. This decision was not determined by the surgeon’s experience, since conversions were performed at any stage of the study period. In our hands, conversion seems typical for redo cases, as the rate is much lower in our matched controls (0.6%), which is lower than in large consecutive cohorts (3-5.7%).168,179 On the other hand, our conversion rate in redo patients is high compared to Panico (0%), yet that study may not have included all consecutive patients booked for LSCP.173 The operation time we recorded was comparable to that of Panico, even if the operative technique was not identical.173 First, in our practice, we do not routinely remove the initial mesh. In only 2/39 (5.1%) of the redo procedures, the initial mesh was excised to facilitate the placement of a new implant. Second, we always dissect the entire vault and place an anterior and posterior mesh (in contrast to Panico, where in none of the redo procedures a dissection of the posterior compartment was performed). It was also comparable to that of our controls, which is somewhat counterintuitive. At closer look, the operation time of redo procedures was not normally distributed but rather bimodal. In shorter operations this coincided with the availability of mesh still properly fixed at the promontory or vault which was used to fix the new implant (17/39 cases), while in others a more difficult
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