Departments of Obstetrics and Gynecology, Duke University, Durham, North Carolina, Columbia University Medical Center and Icahn School of Medicine at Mount Sinai, New York, New York, University of Texas Health Science Center, San Antonio, Texas, Henry Ford Health System, Detroit, Michigan, University of New Mexico, Albuquerque, New Mexico, University of Maryland Medical Center, Baltimore, Maryland, Hartford Hospital, Hartford, Connecticut, Summa Health System, Akron, Ohio, and Alpert Medical School of Brown University, Providence, Rhode Island; and the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.
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OBJECTIVE:To systematically review outcomes after mesh sacrocolpopexy compared with native tissue vaginal repairs in women with apical prolapse.DATA SOURCES:We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov through June 4, 2012.METHODS OF STUDY SELECTION:For anatomic and functional analyses, we included studies comparing mesh sacrocolpopexy to native tissue vaginal repairs with at least 6 months follow-up. The primary outcome was anatomic “success” after surgery. Secondary outcomes were reoperation and symptom outcomes. We included large case series and comparative studies with shorter follow-up to increase power for adverse event analyses.TABULATION, INTEGRATION, AND RESULTS:Evidence quality was assessed with the Grades for Recommendation, Assessment, Development and Evaluation system. Meta-analyses were performed when at least three studies reported the same outcome. We included 13 comparative studies for anatomic success, reoperation, and symptom outcomes. Moderate-quality evidence supports improved anatomic outcomes after mesh sacrocolpopexy; very low-quality evidence shows no differences in reoperation between sacrocolpopexy and native tissue vaginal repairs. Evidence was insufficient regarding which procedures result in improved bladder or bowel symptoms. Low-quality evidence showed no differences in postoperative sexual function. Adverse event data were compiled and meta-analyzed from 79 studies. When including larger noncomparative studies, ileus or small bowel obstruction (2.7% compared with 0.2%, P<.01), mesh or suture complications (4.2% compared with 0.4%, P<.01), and thromboembolic phenomena (0.6% compared with 0.1%, P=.03) were more common after mesh sacrocolpopexy compared with native tissue vaginal repairs.CONCLUSION:When anatomic durability is a priority, we suggest that mesh sacrocolpopexy may be the preferred surgical option. When minimizing adverse events or reoperation is the priority, there is no strong evidence supporting one approach over the other.