A comparison of two different mesh kit systems for anterior compartment prolapse repair

Vivien Wong, Ka Lai Shek, Ajay Rane, Joseph Lee, Anna Rosamilia, Hans Peter Dietz
Australian & New Zealand Journal of Obstetrics & Gynaecology 2014, 54 (3): 212-7

BACKGROUND AND AIM: Mesh reinforcement is considered an effective method for anterior compartment prolapse repair. Two common methods of mesh reinforcement involve either transobturator fixation (eg Perigee™) or lateral and apical anchoring (eg Anterior Elevate™). The aim of this study was to assess subjective and objective outcomes after Anterior Elevate and Perigee mesh kit surgery.

MATERIALS AND METHODS: This was a surgical audit of patients after anterior colporrhaphy (AC) with mesh reinforcement, undertaken at three tertiary urogynaecological centres. All patients were assessed for prolapse recurrence, which was defined as either (i) symptoms of prolapse (vaginal lump/dragging), (ii) ICS POPQ ≥ Stage 2, or (iii) bladder descent ≥10 mm below the symphysis pubis on transperineal ultrasound. Mesh co-ordinates and organ descent on Valsalva were determined relative to the inferior symphyseal margin.

RESULTS: Two hundred and twenty-nine patients with anterior compartment mesh (138 Perigee, 91 Elevate) were assessed at a median follow-up of 1.09 years (IQR 0.65-2.01). On assessment, 24% (n = 55) had symptoms of prolapse recurrence, 46% (n = 106) had a clinical recurrence, and 41% (n = 95) a recurrent cystocele sonographically. All objective results favoured the Perigee group. The superiority of the Perigee kit remained highly significant (P < 0.0001 for all clinical and ultrasound measures of prolapse recurrence) on multivariate analysis.

CONCLUSIONS: This retrospective analysis suggests that apical anchoring such as Anterior Elevate mesh system does not necessarily confer an advantage over the original transobturator mesh fixation technique for anterior compartment reconstruction.

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