title: Surgical outcomes of anterior trans-obturator mesh and vaginal sacrospinous ligament fixation for severe pelvic organ prolapse in overweight and obese Asian women.
abstract: OBJECTIVE
  The aim of this study is to compare the outcomes of patients who underwent surgical repair of advanced pelvic organ prolapse amongst with normal-weight, overweight and obese Asian women.
  
  
  METHODS
  Vaginal sacrospinous ligament fixation with anterior mesh repair as primary surgery was performed on 200 patients with advanced pelvic organ prolapse (POP-Q ≥ stage III). POP-Q < stage II was objective cure and subjective cure was based on POPDI-6 (questions 2 and 3). Patients completed the UDI-6, IIQ-7, POPDI-6, and PISQ-12 pre- and post-surgery. Outcome measures were observed in three categories of Asian BMI (normal weight 18.5 to 23.0 kg/m(2), overweight >23.0 to 27.5 kg/m(2), and obese ≥ 27.5 kg/m(2)).
  
  
  RESULTS
  Postoperative data were available for 195 patients. Objective cure for the normal-weight, overweight, and obese were 93.0%, 92.5% and 90.6% respectively with an overall mean follow-up of 35.69 ± 18.97 months. The subjective cure was no different. All categories improved significantly with regard to anatomical outcome, UDI-6, IIQ-7, POPDI-6, PISQ-12 after primary surgery (p < 0.05) and none had recurrence requiring further surgery. However, obese patients have significantly less improvement in POPDI-6 (p <0.037) and PISQ-12 (p <0.005) compared with normal weight. There were no differences with regard to perioperative complications and the vaginal mesh exposure rate was 4.1%.
  
  
  CONCLUSIONS
  There was no difference in the objective outcome of sacrospinous ligament fixation with anterior mesh repair surgery among the three Asian BMI categories; however, obese patients showed less improvement in POP symptoms and sexual function.
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, 5, Fu-Hsin Street, Kwei-shan, Taoyuan, 333, Taiwan, Republic of China. 2378@cgmh.org.tw
authors.forename: Tsia-Shu
authors.initials: TS
authors.lastname: Lo
authors.forename: Yiap Loong
authors.initials: YL
authors.lastname: Tan
authors.forename: Siwatchaya
authors.initials: S
authors.lastname: Khanuengkitkong
authors.forename: Anil Krishna
authors.initials: AK
authors.lastname: Dass
mesh_terms: D000368:Aged; D044466:Asian People; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D056887:Pelvic Organ Prolapse / Q000150:complications* / Q000601:surgery*; D012189:Retrospective Studies; D053825:Suburethral Slings; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery