Chapter 4.2.2 96 dissection of the vaginal vault due to fibrosis from prior surgery substantially prolonged the operation time. We were able to identify the cause of prolapse recurrence in the surgical notes of 21/39 (53.8%) redo patients. Except for one heavy-smoking patient with chronic obstructive pulmonary disease (COPD) in whom the mesh detached from the promontory due to excessive coughing upon awakening, all failures occurred at the level of the vault. We routinely use tackers to attach the implant to the promontory (and did so also in the patient with early apical failure) and Polydioxanone sutures to fix the mesh to the vault. In redo patients, all reinterventions for complications beyond 3 months were for symptomatic GRC. In primary cases, GRC also typically occur late (> 12 months) after surgery.176 Indeed, all reinterventions in our redo cohort were performed between 27-106 months postoperatively. The other study by Panico does not report GRC’s, which may be due to their short follow-up.173 The strengths of our study are its prospective data collection, the inclusion of all consecutive patients having undergone a redo LSCP, the matching with ‘unselected’ primary cases who were operated during the same timeframe by or under the supervision of one surgeon (hence, the level of experience and other surgical variables such as the type of implant were comparable), and followup by independent assessors. Also, we provide outcome data at a median of more than five years, as compared to one year in the single other cohort study on redo LSCP published to date.173 We also acknowledge limitations to our study. First, despite our efforts to cover as much as possible all patients, data on complications and reinterventions in non-respondents was gathered using the national electronic record or by contact with the general practitioner if the former was not available. This may have caused underreporting, since only visits in affiliated hospitals from 2015 onwards are recorded in this database. Second, only 56.4% of redo patients were clinically assessed, which may have led to selection bias. Actually, we observed significantly higher subjective cure rates in patients assessed in person as compared to those interviewed remotely. Therefore, it is possible that the true objective cure rate is lower than what we report. Third, because of the limited number of redo procedures we performed, our sample size was too small to judge on significance even though we tried to increase power by setting our matching ratio to 1:4. Finally, this study was performed in a referral center where all procedures were performed by or under the supervision of one trainer, making the results less generalizable. In conclusion, we provide complication rates and outcomes that fall within the range of what is reported on primary LSCP. There was a higher rate of conversion, and we did observe a trend for more GRC and reinterventions for GRC. Our data suggest that a redo LSCP is feasible and effective in experienced hands and can therefore be considered as an option when counseling patients with post-sacropexy apical prolapse.
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