Vaginal reconstruction effectiveness and safety: Comparison of anterior versus posterior pelvic floor compartment reinforcement with partially absorbable mini mesh implant in 500 cases of apical pelvic organ prolapse

Objective: To assess the vaginal reconstruction effectiveness and safety, comparing anterior versus posterior pelvic floor compartment reinforcement with partially absorbable mini mesh implant in 500 cases of apical pelvic organ prolapse (aPOP). Materials and Methods: The seratom PA MR MN® (Serag Wiessner, Naila, Germany) lightwheight partially absorbable mini mesh implants were used to treat stage II or greater apical and anterior or posterior pelvic floor compartment prolapse in women with aPOP. The patients were divided into two groups: Those with anterior prolapse predominance, for whom an anterior mini-mesh was implanted, and those with posterior prolapse predominance, for which a posterior mini-mesh was placed. The patients reported their functional outcomes on the first post-operative day (POD1) after surgery, one month, and four months afterwards. Anatomical outcomes were evaluated 1 month after surgery, using POP quantification (POP-Q) staging system. The reports of intra and post-operative (post-op) complications, post-op lower urinary tract symptoms, bowel symptoms and dyspareunia, anatomical and functional cure rates, were tabulated and assessed. The absence of bulging symptoms combined with no protrusion past the hymenal ring upon physical examination along with absence of surgery related adverse events or complications was considered success. Patient was considered satisfied if the operation was successful and subjective ecpectations were fulfilled at >80%. Results: The study population (n=500) had a mean age of 62.7±9.4 years. Concomitant anterior and posterior colporrhaphy was performed in all cases. Four hundred fifty-two patients had completed medical files and follow-up (F/U) records, 48 patients (9.6%) had missing files or were lost to F/U. Three hundred ten individuals made up the anterior mini mesh group the first group. 12% of the patients of the first group had prior hysterectomies, 114 patients (36.7%) reported urgency-related stress incontinence (USI). The preoperative mean POP-Q C point was 1.1 [0-(+)15], the Ba point was 4.01 [(-)2-(+)10], and the Bp was 0.8 [(-)3-(+)10]. 95.2% of the patients were satisfied at the 4-month F/U. Of the 142 patients in the second group, 28 (20%) had a prior hysterectomy, 48 (33.8%) reported USI. The preoperative POP-Q C point mean was 1.66 [0-(+)12], the Ba point was 1.27 [(-)2-(+)3], and the Bp was 1.9 [(-)2-(+)3]. At the 4-month F/U, the patient’s satisfaction rating was 88.65%. Conclusion: Excellent anatomical and quality of life outcomes were seen in patients treated with the seratom PA MR MN® mini-mesh system for POP, according to this current study. Within the 4-months after surgery, there was only one report of mesh exposure that was successfully treated surgically, and no other mesh related complications.