Determinants of Dissatisfaction After Laparoscopic Cure of Vaginal and/or Rectal Prolapse using Mesh: a Comprehensive Retrospective Cohort Study

• Published in: International Urogynecology Journal 2024-02, Vol.35 (2), p.457-465
• Main Authors: Arab, Wissam, Lukanović, David, Matjašič, Miha, Blaganje, Mija, Deval, Bruno
• Format: Article
• Language: English
• Subjects: Aged; Fecal Incontinence - surgery; Female; Gynecology; Humans; Laparoscopy; Medicine; Medicine & Public Health; Middle Aged; Original Article; Patient satisfaction; Rectal Prolapse - surgery; Retrospective Studies; Surgical Mesh; Treatment Outcome; Urology; Uterine Prolapse - surgery; Vagina
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-023-05701-3

Introduction and Hypothesis The primary objective is to identify determinants of dissatisfaction after surgical treatment of vaginal prolapse ± rectal prolapse, using laparoscopic mesh sacrohysteropexy (LSH) or sacrocolpopexy (LSC) ± ventral mesh rectopexy (VMR). The secondary objective is the evaluation of complications and objective/subjective recurrence rates. Methods The study performed was a single-surgeon retrospective review of prospectively collected data. LSH/LSC ± VMR were performed between July 2005 and September 2022. Primary investigated outcome was patients’ satisfaction, assessed using the Patient Global Impression of Improvement (PGI-I) score and the bother visual analog scale (VAS) obtained postoperatively (at a 1-month interval and on a 6-month/yearly basis thereafter). We looked for a correlation between the level of satisfaction (as reflected by the VAS) and potential determinants. Results There were 355 patients with a mean age of 62 ±12 years. Nearly all the patients (94.3%) had a stage 3 or 4 prolapse according to the POP-Q classification. The mean postoperative bother VAS was 1.8, with only 12.7% of patients reporting a bother VAS score ≥ 3/10, indicating a dissatisfaction. PGI-I showed improvement in the vast majority of patients (96.4% scoring 1 to 3). Patients with anal incontinence preoperatively scored higher on the bother VAS postoperatively (r=0.175, p < 0.05). The use of a posterior arm mesh (for posterior vaginal prolapse) correlated with better satisfaction overall (r= −0.178, p = 0.001), whereas the performance of VMR was associated with a bothering sensation (r = 0.232, p < 0.001). A regression analysis confirmed the impact of posterior mesh and VMR on satisfaction levels, with odds of dissatisfaction being 2.18 higher when VMR was combined with LSH/LSC. Conclusions Posterior mesh use improves patient satisfaction when the posterior compartment is affected. In patients with concomitant vaginal and rectal prolapse, combining VMR with anterior LSC/LSH appears to negatively impact patients’ satisfaction. Preoperative anal incontinence was demonstrated to be a risk factor for postoperative dissatisfaction.