title: Transvaginal Versus Transabdominal Placement of Synthetic Mesh at Time of Sacrocolpopexy.
abstract: Our primary aim was to compare mesh-related complications at the time of total vaginal hysterectomy with laparoscopic sacrocolpopexy (TVH-LSC) versus laparoscopic placement of sacrocolpopexy mesh at time of laparoscopic supracervical hysterectomy (LSH-LSC). Our secondary aim was to compare operative time, intraoperative and postoperative complications, as well as subjective and objective success between these groups.
  
  
  
  We performed a retrospective cohort study with prospective follow-up for patients with uterovaginal prolapse who underwent TVH-LSC or LSH-LSC from June 2008 to July 2012. We collected baseline demographics, mesh-related complications, intraoperative and postoperative complications, and pelvic organ prolapse quantification data. We contacted patients postoperatively for telephone interviews and to request a return to the office for repeat examination.
  
  
  
  One hundred eighty-two patients were included: 123 TVH-LSC and 59 LSH-LSC. There was no difference in the rate of mesh-related complications (1.6% [2/123]; 95% confidence interval, 0-3.86% vs 1.7% [1/59]; 95% confidence interval, 0-4.99%; P = 1.0). Median examination follow-up was similar between groups (9 (2-17) months TVH-LSC vs 9 (2-17) months LSH-LSC, P = 1.0).The TVH-LSC was associated with a significantly shorter operative time (256 ± 53 vs 344 ± 81 minutes; P < 0.01). There were no differences in intraoperative or postoperative complications or subjective and objective success between groups.
  
  
  
  There was no difference in mesh-related complications between groups (1.6% TVH-LSC vs 1.7% LSH-LSC; P = 1.0). Vaginal mesh attachment during TVH-LSC decreased operative time by over 1 hour with no differences in intraoperative complications, reoperation for recurrent prolapse, and subjective or objective outcomes compared to LSH-LSC.
authors.affiliation: From the *Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Women and Infants' Services, MedStar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC; and †Department of Biostatistics and Epidemiology, Medstar Health Research Institute, Hyattsville, MD.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Nosti
authors.forename: Charelle M
authors.initials: CM
authors.lastname: Carter
authors.forename: Andrew I
authors.initials: AI
authors.lastname: Sokol
authors.forename: Eshetu
authors.initials: E
authors.lastname: Tefera
authors.forename: Cheryl B
authors.initials: CB
authors.lastname: Iglesia
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Park
authors.forename: Robert E
authors.initials: RE
authors.lastname: Gutman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D007431:Intraoperative Complications; D010535:Laparoscopy; D008875:Middle Aged; D061646:Operative Time; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications; D011184:Postoperative Period; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh / Q000009:adverse effects*; D014621:Vagina / Q000601:surgery