[Prevention of the complications related to the use of prosthetic meshes in prolapse surgery: guidelines for clinical practice - literature review]

X Deffieux, D Savary, V Letouzey, L Sentilhes, A Agostini, P Mares, F Pierre
Journal de Gynécologie, Obstétrique et Biologie de la Reproduction 2011, 40 (8): 827-50

OBJECTIVE: To provide guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF), based on the best evidence available, concerning the adverse events related to surgical procedures involving the use of prosthetic meshes.

MATERIALS AND METHODS: French and English-language articles from Medline, PubMed, and the Cochrane Database were searched, using key words (mesh ; pelvic organ prolapse ; cystocele ; rectocele ; uterine prolapse ; complications ; adverse event ; sacral colpopexy ; extrusion ; infection...).

RESULTS: As with any surgery, it is recommended to provide a perioperative smoking cessation (expert opinion) and comply with the prevention of nosocomial infections (regulatory requirement). There is no evidence to recommend routine local or systemic estrogen therapy before or after prolapse surgery using mesh, regardless of the surgical approach (grade C). Antibiotic prophylaxis is recommended, regardless of the approach (expert opinion). It is recommended to seek a pre-operative urinary tract infection and treat it (expert opinion). The first cases should be made under the guidance of an experienced surgeon in the relevant technique (grade C). It is recommended not to place a non-absorbable synthetic mesh into the rectovaginal septum when a rectal injury occurs (expert opinion). The placement of a non-absorbable synthetic mesh into the vesicovaginal septum may be considered after the suture of a bladder injury if the suture is considered to be satisfactory (expert opinion). If a synthetic mesh is placed by vaginal route, it is recommended to use a macroporous polypropylene monofilament mesh (grade B). It is recommended not to use polyester mesh for vaginal surgery (grade B). It is allowed to perform a hysterectomy associated with the placement of a non-absorbable synthetic mesh placed by vaginal route but this is not routinely recommended (expert opinion). It is recommended to minimize the extent of the colpectomy (expert opinion). Laparoscopic approach is recommended for sacral colpopexy (grade C). It is recommended not to place and suture meshes by vaginal route when a sacral colpopexy is performed (grade B). It is recommended not to use silicone-coated polyester, porcine dermis, fascia lata, and polytétrafluoroéthylène meshes (grade B). It is recommended to use polyester (without silicone coating) or polypropylene meshes (grade C). Suture of the meshes to the promontory can be performed using thread/needle or tacker (grade C). A peritonization is recommended to cover the meshes (grade C). If hysterectomy is required, it is recommended to perform a subtotal hysterectomy (grade C).

CONCLUSION: Implementation of this guideline should decrease the prevalence of complications related to surgical procedures involving the use of prosthetic meshes.

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