MESH-RELATED COMPLICATIONS AFTER IMPLANTATION OF SYNTHETIC MESHES USING TROCAR AND ANCHORING SYSTEMS

Aim. To reduce incidence of mesh-related complications by comparative analysis of the results of vaginal extraperitoneal mesh-vaginopexy with use of trocar and anchoring systems.

Materials and methods. A retrospective analysis of outpatient and hospital charts of 160 patients was performed, who underwent operative treatment of genital prolapse by vaginal extraperitoneal vaginopexy with Prolift, Johnson & Johnson, USA, Pelvix (Lintex, RF), Elevate (AMS, USA) and the Calistar system (Promedon, Argentina). The duration of postoperative follow-up was 3 years. In the 1st group, the patients were operated on using trocar techniques (Prolift, Pelvix). The second group consisted of patients operated on with the use of anchor technologies using the Elevate and Calistar methods. The degree of prolapse of the genitals was determined by the POP-Q system. The index of the influence of genital prolapse on the quality of life (IVQV) was assessed using a validated PD-QL questionnaire. To verify the accuracy of the hypothesis, Chi-square was used. Differences were considered valid for p<0,05.

Results. In group 1, the mean time of surgery was 98±26 min. The frequency of erosions of the vaginal mucosa was 10,9%, in 4,1% of cases, a partial excision of the implant was carried out. In 1,4% there was a wrinkling of the implant, accompanied by a pain relief syndrome, in connection with which the implant was partially excised. Chronic pelvic pain was noted in 11,3% of patients. Dyspareunia de novo was noted in 11,0% of patients. Infection of the implant was observed in 2,7%, the implant was removed. Implant protrusion into the bladder occurred in 1 patient, the implant was partially excised. The frequency of recurrence of prolapse of the genitals was 10,4%. In group 2, the mean time of surgery was 79±32 min. The frequency of erosions of the vaginal mucosa was 3.1%, in 1 case, partial excision of the implant was required. Dyspareunia de novo was noted in 6,1% of patients, in 1 of them the implant was partially excised. Chronic pelvic pain was noted in 3,1% of patients − the pain syndrome was treated conservatively. The frequency of recurrence of genital prolapse in the 2nd group was 9,8%.

Conclusion. Surgical treatment of genital prolapse with the use of synthetic meshes is highly effective, with both trocar and anchoring systems in use. It is advisable to give preference to anchor technologies, given the lower frequency of meshrelated complications.

1. Пушкарь Д.Ю., Касян Г.Р. Ошибки и осложнения в урогинекологии. Москва: «ГЭОТАР-Медиа»; 2017. 384 с. [Pushkar' D. Ju.,Kasjan G. R. Oshibki I oslozhnenija v uroginekologii. Moskva: «GJeOTAR-Media»; 2017. 384 p. (In Russ.)].

2. Kasyan G.R., Abramyan K.N., Popov A.A., Pushkar D. Risk factors associated with perioperative and mesh-related complications for patients undergoing pelvic organ prolapse surgery: analysis of 677 cases. Eur. Urol. Suppl. 2013; 27 (3): 1081-1086.

3. Pushkar D., Malkhasyan V.A., Kasyan G.R., Gvozdev M.Y. et al. Anatomical and functional results in patient for pelvic organ prolapse using Prolift transvaginal mesh: a prospective study of 105 cases. Eur. Urol. Suppl. 2011; 10 (2): 245.

4. Кулаков В.И., Манухина И.Б., Савельева Г.М. Гинекология. Национальное руководство. М: ГЭОТАР-Медиа; 2007. 857-858. [Kulakov V. I., Manuhina I. B., Savel'eva G. M. Ginekologija. Nacional'noe rukovodstvo. M: GJeOTAR-Media; 2007. 857-858. (In Russ.)].

5. Шкарупа Д. Д., Кубин Н. Д. Протезирующая реконструкция тазового дна влагалищным доступом: современный взгляд на проблему. Экспериментальная и клиническая урология. 2015; 1: 88-93. [Shkarupa D. D., Kubin N. D. Prosthetic reconstruction of the pelvic floor using vaginal approach: contemporary view. Experimental and Clinical Urology. 2015; 1: 88-93. (In Russ., English abstract)].

6. Cosson M., Debodinance Ph., Boukerrou M., Chauvet M.P., Lobry P., Crepin G., Ego A. Mechanical properties of synthetic implants used in the repair of prolapse and urinary incontinence in women: which is the ideal material. Int. Urogynecol. J. 2003; 14: 169-78.

7. Scheiidbach H., Tamme C., Tannapfel A., Lippert H., Kockerling F. In vivo studies comparing the biocompatibility of various polypropylene meshes and their handling properties during endoscopic total extraperitoneal (TEP) patchplasty: an experimental study in pigs. Surg. Endosc. 2004; 18: 211-220.

8. Смольнова Т.Ю., Адамян Л.В. Диагностика и тактика ведения больных с дисплазией соединительной ткани в акушерстве и гинекологии. РМЖ. 2010; 6: 41-46. [Smol'nova T. Ju., Adamjan L.V. Diagnostika i taktika vedenija bol'nyh s displaziej soedinitel'noj tkani v akusherstve i ginekologii. RMZh. 2010; 6: 4146 (In Russ.)].

9. Maher C, Baessler K, Barber M, Cheon C, Deitz V, DeTayrac R, Gutman R, Sentilhes L, Karram M. Pelvic organ prolapse surgery. Incontinence. 5th International Consultation on Incontinence [eds., P. Abrams, L. Cardozo, S. Khoury, A. Wein]. Paris: HealthPublicationLtd. 2013: 1377-1442.

10. Коршунов М.Ю., Сазыкина Е.И. Опросник ПД-КЖ – валидированный способ оценки симптомов дисфункций тазового дна и качества жизни у пациенток с пролапсом тазовых органов. Ж. акуш. и жен. болезн. 2008; 3: 86-93. [Korshunov M.Y., Sazykina E.I. PD-QL Questionnaire − validated instrument for symptoms and quality of life assessment in patients with pelvic organ prolapse. Zh. akush. i zhen. bolezn. 2008; 3: 86-93. (In Russ., English abstract)].

11. Пучков К.В., Подзолкова Н.М., Коренная В.В. Хирургические протоколы ускоренной реабилитации в оперативной гинекологии. Москва: Швейцарская университетская клиника; 2016. 31 с. [PuchkovK.V., Podzolkova N.M., Korennaja V.V. Hirurgicheskie protocol yuskorennoj reabilitacii v operativnoj ginekologii. Moskva: Shvejcarskaja universitetskaja klinika; 2016: 31 p. (In Russ.)].

12. Pushkar D., Vasilchenko M., Kasyan G.R. et al. Necrotising fasciitis after hysterectomy and concomitant transvaginal mesh repair in a patient with pelvic organ prolapse. Int. Urogynecal. J. 2013; 24(10): 1765-1767.