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Fong E, Yao HHI, Zargar H, Connell HE. Early experience of transabdominal and novel transvaginal robot-assisted laparoscopic removal of transvaginal mesh. J Endourol 2021; 36:477-492. [PMID: 34931531 DOI: 10.1089/end.2021.0520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Mesh removal following transvaginal mesh placement has typically involved transvaginal, open pelvic, laparoscopic or a combination of approaches. Robotic pelvic mesh removal has been described in a small number of cases only. This study aims to determine the feasibility and safety of using robot-assisted laparoscopic surgery in removal of pelvic mesh via trans-abdominal and novel trans-vaginal approach. Materials and methods This is a prospective case series study on women who underwent transabdominal or transvaginal robot-assisted removal of pelvic mesh. Women were offered participation in this study if they were over the age of 18 with pelvic mesh and a clinical indication for mesh removal. Alternative surgical options including conventional open removal of mesh were discussed and offered to patients. The primary outcome of this study is the rate of successful removal of mesh and the 30-day complication rates. Ethics approval was obtained for this study. Results Thirty patients were included in this study. Median age was 62. Median operative and console time was 240 and 148 minutes, respectively. Concomitant reconstructive procedures were performed in 40% of patients. Complete or near-complete mesh removal was achieved in 83.3% of patients. For the remaining patients, partial removal of mesh was performed as planned pre-operatively. Three Clavien-Dindo grade 3b complications resulted from mesh removal: concomitant ureteric and bladder injury, omental bleed and groin wound infection. Conclusion This study presents the early experience of robotic-assisted removal of transvaginal mesh with a transvaginal or transabdominal approach and demonstrated feasibility of removal of both retropubic and transobturator MUSS as well as trans-vaginal prolapse meshes with transobturator and sacrospinous mesh arms. Further studies are required to expand understanding on the learning curve, operating times, complication rates and functional outcome of this operation.
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Affiliation(s)
- Eva Fong
- Department of Urology, Urology Institute, Auckland, New Zealand
| | | | | | - Helen E Connell
- Epworth Healthcare, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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Pace N, Artsen A, Baranski L, Palcsey S, Durst R, Meyn L, Moalli PA. Symptomatic improvement after mesh removal: a prospective longitudinal study of women with urogynaecological mesh complications. BJOG 2021; 128:2034-2043. [PMID: 34047446 PMCID: PMC8497415 DOI: 10.1111/1471-0528.16778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare clinical characteristics and outcomes in patients undergoing excision of polypropylene urogynaecological mesh for pain, mesh exposure or both. DESIGN Prospective, longitudinal cohort. SETTING Academic tertiary referral centre. POPULATION Women undergoing complete vaginal mesh excision for mesh exposure and/or pain. METHODS Clinical and patient-reported outcomes assessing pain (visual analog scale, VAS), bother (Pelvic Floor Distress Inventory, PFDI) and functional impact (Pelvic Functional Impact Questionnaire, PFIQ) were collected at baseline, 6, 12 and 24 months after complete mesh excision. Outcomes were compared by mesh type (sling, prolapse [transvaginal or sacrocolpopexy mesh], both) and complication (pain, exposure, both). MAIN OUTCOME MEASURES 'Much better' or 'Very much better' on Patient Global Impression of Improvement (PGI-I) up to 2 years after removal. RESULTS Of 173 women, 48 underwent removal for pain, 27 for exposure and 98 for exposure plus pain. 'Moderate to severe' baseline symptoms were reported by 75%; the most prevalent and severe symptom was dyspareunia. Patients with pain alone were most bothered (PFDI median 234.2, interquartile range 83, P = 0.02) and had the highest functional impact (PFIQ median 181, interquartile range 138, P < 0.001). After excision, only 33.3% of women with pain alone reported 'improved' symptoms (PGI-I), versus 73.9% with exposure, 58.3% with exposure plus pain (P = 0.03) with no differences in PGI-I by mesh type. VAS scores decreased in all groups, but PFDI and PFIQ did not improve in pain patients. CONCLUSIONS In women experiencing a pain complication after urogynaecological mesh insertion, mesh removal often does not improve symptoms. TWEETABLE ABSTRACT Only 33% of women with pain complications have improved symptoms after urogynaecological mesh removal.
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Affiliation(s)
- N Pace
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - A Artsen
- Department of Obstetrics, Gynecology & Reproductive Sciences, Women's Center for Bladder & Pelvic Health, UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - L Baranski
- Department of Obstetrics, Gynecology & Reproductive Sciences, Women's Center for Bladder & Pelvic Health, UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
| | - S Palcsey
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - R Durst
- Department of Obstetrics, Gynecology & Reproductive Sciences, Women's Center for Bladder & Pelvic Health, UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
| | - L Meyn
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - P A Moalli
- Department of Obstetrics, Gynecology & Reproductive Sciences, Women's Center for Bladder & Pelvic Health, UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
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Akbaba E, Sezgin B. Modified laparoscopic lateral suspension with a five-arm mesh in pelvic organ prolapse surgery. BMC WOMENS HEALTH 2021; 21:244. [PMID: 34130664 PMCID: PMC8207729 DOI: 10.1186/s12905-021-01388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/07/2021] [Indexed: 12/02/2022]
Abstract
Background Laparoscopic lateral suspension (LLS) is a laparoscopic technique used to treat pelvic organ prolapse (POP) in apical and anterior compartment defect with the use of a synthetic T-shaped mesh graft. The posterior compartment is repaired using a second mesh or a procedure along with LLS, such as posterior colporrhaphy. The aim of this study was to evaluate the clinical results of LLS for POP using a five-arm mesh instead of a T-shaped mesh graft to repair the defect of the posterior compartment in addition to the apical and anterior compartments.
Methods Data from 37 patients with a diagnosis of advanced-stage (≥ 3) POP undergoing LLS with the use of a five-arm mesh were retrospectively analysed. Pre-operative and post-operative examinations and, surgical outcomes were determined. The results of measurements and examinations, reoperation rates, erosion rates, lower urinary tract symptoms, and complications were analysed. The Prolapse Quality of Life Questionnaire (P-QOL) was also used. Results The median post-operative follow-up was 20 (13–34) months. There was a significant improvement in POP-Q scores in all treated compartments, with overall objective cure rates of 94.5% for the apical compartment, 86.4% for the anterior compartment, and 91.8% for the posterior compartment. The median operative time was 96 (76–112) minutes. The median length of hospitalization was 2 (1–3) days. A significant improvement in vaginal bulge, urinary urgency, incomplete voiding, urinary frequency, and constipation was observed after surgery. The sexuality among patients increased from 13 (35.1%) preoperatively to 22 (59.4%) post-operatively. De novo stress urinary incontinence developed in 7 (18.9%) patients. The P-QOL scores improved significantly after surgery. Conclusions In advanced-stage POP patients, the posterior compartment damage can also be repaired in LLS with the use of a single five-arm mesh without the need for an additional procedure, and the recurrence rate can be reduced.
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Affiliation(s)
- Eren Akbaba
- Obstetrics and Gynecology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey.
| | - Burak Sezgin
- Obstetrics and Gynecology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
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Immunochemical and urodynamic outcomes after polypropylene mesh explant from the pelvic wall of rats. Int Urogynecol J 2021; 33:1839-1848. [PMID: 34037814 DOI: 10.1007/s00192-021-04842-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To analyze the immunochemical and urodynamic outcomes after partial versus complete excision of transvaginal polypropylene mesh (PPM) from pelvic walls of rats. METHODS Forty-eight female Sprague-Dawley (SD) rats were randomly distributed into seven groups: control, mesh total removal 60 days (M-T 60D), mesh total removal 180 days (M-T 180D), mesh partial removal 60 days (M-H 60D), mesh partial removal 180 days (M-H 180D), sham 60 days (Sham 60D), and sham 180 days (Sham 180D). In the mesh groups, PPM was inserted and partially (0.3 × 0.3 cm) or completely removed 30 days later. In the Sham group, the space between the vagina and bladder was dissected without placing or removing the synthetic mesh at day 1 and day 30 later. Urodynamic studies, immunochemical analysis, and Western blot were done at days 60 and 180. RESULTS The M-T 60D voiding pressure was significantly decreased compared to the Sham 60D and M-H 60D. The voiding interval of M-T 60D was significantly shorter than that of M-H 60D. In the M-T 60D and M-T 180D groups, the leak point pressure was significantly less than in their corresponding sham groups. IL-1 and TNF-α were significantly more intense in M-T 60D compared to M-H 60D and Sham 60D. NGF was significantly greater in M-T 60D compared to Sham 60D. There were no significant differences in MMP-2 and CD-31s throughout the group. CONCLUSION Total mesh excision incites a host inflammatory response and transitory lower urinary tract dysfunction. Despite the good outcomes after total excision, the invasiveness and surgical risk associated with repeated procedures should not be underestimateded.
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Morton S, Wilczek Y, Harding C. Complications of synthetic mesh inserted for stress urinary incontinence. BJU Int 2020; 127:4-11. [PMID: 32981191 DOI: 10.1111/bju.15260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/24/2020] [Accepted: 09/24/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To provide an update on the literature regarding the management of complications secondary to synthetic mesh placed to treat stress urinary incontinence (SUI). METHODS We performed a systematic review of the literature using a multi-database structured search within OVID, the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE) and Cochrane library databases; using the keywords: urology, incontinence, mesh and surgery. RESULTS Several million synthetic polypropylene meshes have been inserted into women worldwide to manage SUI. Unfortunately, a significant number of women have now reported life-changing complications. We found a paucity of studies, heterogeneity of cohorts, poor long-term follow-up, and lack of evidence on the effective management of mesh-related complications. CONCLUSIONS The contemporary evidence is low-level and often contradictory, which prevents robust recommendations regarding treatment. A prospective registry will be required to generate meaningful outcome data and help in the complex management of patients who have mesh-related complications.
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Affiliation(s)
- Simon Morton
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Yasmine Wilczek
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
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Giarenis I, Anding R, Chermansky C, Greenwell T, Cardozo L, Harding C. Do we have adequate data to construct a valid algorithm for management of synthetic midurethral sling complications? ICI-RS 2019. Neurourol Urodyn 2020; 39 Suppl 3:S122-S131. [PMID: 32022954 DOI: 10.1002/nau.24299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/14/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Synthetic midurethral sling (MUS) procedures, purported for the last two decades as the gold standard surgical treatment for stress urinary incontinence, have been in creasingly scrutinized in recent years with regard to the rate and severity of complications. METHODS During the International Consultation on Incontinence Research Society meeting held in Bristol, UK, in 2019, a multidisciplinary panel held a think tank and discussed the contemporary evidence pertaining to the classification, investigation, and treatment of MUS complications. RESULTS The current classification system of mesh-related complications was discussed, and shortcomings were identified. The lack of a standardized clinical pathway was noted, and the value of clinical investigations and surgical treatments was difficult to fully evaluate. The paucity of high-level evidence was a common factor in all discussions, and the difficulties with setting up relevant randomized-controlled trials were highlighted. CONCLUSIONS The outcome of the think-tank discussions is summarized with a set of recommendations designed to stimulate future research.
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Affiliation(s)
- Ilias Giarenis
- Department of Urogynaecology, Norfolk and Norwich Hospital, Norwich, UK
| | - Ralf Anding
- Department of Neurourology/Urology, Bonn and Neurological Rehabilitation Center "Godeshöhe" e.V., University Clinic, Friedrich Wilhelms University, Bonn, Germany
| | - Christopher Chermansky
- Department of Female Pelvic Medicine and Reconstructive Urology, UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania
| | - Tamsin Greenwell
- Department of Urology, University College London Hospital, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Christopher Harding
- Department of Urology, Freeman Hospital, Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
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7
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Carter P, Fou L, Whiter F, Delgado Nunes V, Hasler E, Austin C, Macbeth F, Ward K, Kearney R. Management of mesh complications following surgery for stress urinary incontinence or pelvic organ prolapse: a systematic review. BJOG 2019; 127:28-35. [DOI: 10.1111/1471-0528.15958] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2019] [Indexed: 11/27/2022]
Affiliation(s)
- P Carter
- Research Department of Clinical Educational & Health Psychology University College London London UK
| | - L Fou
- National Guideline Alliance Royal College of Obstetricians and Gynaecologists London UK
| | - F Whiter
- National Guideline Alliance Royal College of Obstetricians and Gynaecologists London UK
| | - V Delgado Nunes
- National Guideline Alliance Royal College of Obstetricians and Gynaecologists London UK
| | - E Hasler
- National Guideline Alliance Royal College of Obstetricians and Gynaecologists London UK
| | - C Austin
- National Institute for Health and Care Excellence Manchester UK
| | - F Macbeth
- Centre for Trials Research Cardiff University Cardiff UK
| | - K Ward
- The Warrell Unit St Mary's Hospital Manchester UK
- Manchester Academic Health Science Centre University Hospitals NHS Foundation Trust Manchester UK
| | - R Kearney
- The Warrell Unit St Mary's Hospital Manchester UK
- Manchester Academic Health Science Centre University Hospitals NHS Foundation Trust Manchester UK
- Faculty of Medical Human Sciences University Institute of Human Development University of Manchester Manchester UK
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8
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Wang WJ, Li R, Guo CA, Li HT, Yu JP, Wang J, Xu ZP, Chen WK, Ren ZJ, Tao PX, Zhang YN, Wang C, Liu HB. Systematic assessment of complications after robotic-assisted total versus distal gastrectomy for advanced gastric cancer: A retrospective propensity score-matched study using Clavien-Dindo classification. Int J Surg 2019; 71:140-148. [PMID: 31568844 DOI: 10.1016/j.ijsu.2019.09.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/11/2019] [Accepted: 09/24/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite increasing evidence demonstrated robot-assisted distal gastrectomy (RADG) is safe and feasible for the treatment of advanced gastric cancer (AGC), robot-assisted total gastrectomy (RATG) remains a challenging procedure due to its technical difficulties and possible postoperative complications (POCs). This study aimed to systematically evaluate POCs following RATG. METHODS Between January 2017 and January 2019, 319 AGC patients with pathological stage T2-4aN0-3M0 who underwent RADG or RATG were enrolled. POCs were stratified using the Clavien-Dindo classification. One-to-one propensity score matching was performed to reduce confounding differences. RESULTS After matching, 266 patients met the criteria for further analysis. Ultimately, 64 patients (24.1%) who developed POCs had 126 clinical manifestation events. Overall the POCs rate was significantly greater after RATG in comparison with RADG (29.3% vs. 18.8%; P = 0.045), and more major POCs (Clavien-Dindo grade ≥ IIIa) were observed in the RATG group (14.3% vs. 5.3%; P = 0.013). The POCs were then classified into local and systemic POCs. The rates of local POCs (35.3% vs. 19.5%; P = 0.004) and systemic POCs (24.8% vs. 15.0%; P = 0.046) were significantly higher in the RATG group than the RADG group. Subgroup analysis showed that the anastomotic leakage rate was higher after RATG (5.3% vs. 0.8%; P = 0.031), whereas the remaining POCs were similar between the two groups. Patients with higher POCs significantly had longer postoperative length of stay (R = 0.895, P = 0.003). Multivariate analysis confirmed age, extent of resection, and TNM stage were risk factors for all POCs. CONCLUSIONS These findings demonstrated that RATG is technically feasible and safe for treatment of AGC with acceptable morbidity and mortality rates. The POCs rate of RATG was higher than RADG, especially for anastomotic leakage. More effective anastomotic techniques are needed in RATG to prevent leakage.
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Affiliation(s)
- Wen-Jie Wang
- Second Clinical Medical College, Lanzhou University, Lanzhou, 730030, Gansu, PR China; Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, PR China; Key Laboratory of Stem Cells and Gene Drugs of Gansu Province, Lanzhou, 730050, PR China
| | - Rui Li
- Second Clinical Medical College, Lanzhou University, Lanzhou, 730030, Gansu, PR China; Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, PR China
| | - Chang-An Guo
- Second Clinical Medical College, Lanzhou University, Lanzhou, 730030, Gansu, PR China; Key Laboratory of Stem Cells and Gene Drugs of Gansu Province, Lanzhou, 730050, PR China; Department of Emergency, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, PR China
| | - Hong-Tao Li
- Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, 730050, Gansu, PR China
| | - Jian-Ping Yu
- Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, 730050, Gansu, PR China
| | - Jing Wang
- Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, 730050, Gansu, PR China; Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, Gansu, PR China
| | - Zi-Peng Xu
- Second Clinical Medical College, Lanzhou University, Lanzhou, 730030, Gansu, PR China; Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, 730050, Gansu, PR China
| | - Wei-Kai Chen
- Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, 730050, Gansu, PR China; Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, Gansu, PR China
| | - Zhi-Jian Ren
- Second Clinical Medical College, Lanzhou University, Lanzhou, 730030, Gansu, PR China; Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, PR China
| | - Peng-Xian Tao
- Second Clinical Medical College, Lanzhou University, Lanzhou, 730030, Gansu, PR China; Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, PR China
| | - Ya-Nan Zhang
- Second Clinical Medical College, Lanzhou University, Lanzhou, 730030, Gansu, PR China; Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, PR China
| | - Chen Wang
- Second Clinical Medical College, Lanzhou University, Lanzhou, 730030, Gansu, PR China; Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, PR China.
| | - Hong-Bin Liu
- Second Clinical Medical College, Lanzhou University, Lanzhou, 730030, Gansu, PR China; Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, 730050, Gansu, PR China.
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Bergersen A, Hinkel C, Funk J, Twiss CO. Management of vaginal mesh exposure: A systematic review. Arab J Urol 2019; 17:40-48. [PMID: 31258942 PMCID: PMC6583711 DOI: 10.1080/2090598x.2019.1589787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 11/25/2022] Open
Abstract
Objectives: To identify various predisposing factors, the clinical presentation, and the management of vaginal mesh-related complications, with special emphasis on mesh exposure and the indications for and results of vaginal mesh removal. Methods: A systematic literature review was performed using a search strategy based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. PubMed was queried for studies regarding aetiology, risk factors, and management of vaginal mesh exposure from 1 January 2008 to June 2018. Full-text articles were obtained for eligible abstracts. Relevant articles were included, and the cited references were used to identify relevant articles not previously included. Results: A total of 102 abstracts were identified from the PubMed search criteria. An additional 45 studies were identified based on review of the cited references. After applying eligibility criteria and excluding impertinent articles, 58 studies were included in the final analysis. Conclusion: Numerous studies have found at least some degree of symptomatic improvement regardless of the amount of mesh removed. Focal areas of exposure or pain can be successfully managed with partial mesh removal with low rates of complications. With partial mesh removal, many patients will ultimately require subsequent mesh removal procedures. For this reason, complete mesh excision is an alternative for patients with diffuse vaginal pain, large mesh exposure, and extrusion of mesh into adjacent viscera. However, when considering complete mesh removal, it is important to counsel patients regarding possible complications of removal and the increased risk of recurrent stress urinary incontinence and pelvic organ prolapse postoperatively. Abbreviations: MUS: midurethral sling; OR: odds ratio; POP: pelvic organ prolapse; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-analyses; SUI: stress urinary incontinence; TOT: transobturator; TVT: tension-free vaginal tape
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Affiliation(s)
- Andrew Bergersen
- Department of Surgery, Division of Urology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Cameron Hinkel
- Department of Surgery, Division of Urology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Joel Funk
- Department of Surgery, Division of Urology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Christian O Twiss
- Department of Surgery, Division of Urology, University of Arizona College of Medicine, Tucson, AZ, USA
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10
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Wang WJ, Li HT, Yu JP, Su L, Guo CA, Chen P, Yan L, Li K, Ma YW, Wang L, Hu W, Li YM, Liu HB. Severity and incidence of complications assessed by the Clavien-Dindo classification following robotic and laparoscopic gastrectomy for advanced gastric cancer: a retrospective and propensity score-matched study. Surg Endosc 2018; 33:3341-3354. [PMID: 30560498 DOI: 10.1007/s00464-018-06624-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/04/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Robot-assisted gastrectomy (RAG) has been increasingly used for the treatment of advanced gastric cancer (AGC), and many advantages over laparoscopy-assisted gastrectomy (LAG) have been reported. However, its postgastrectomy complications still under investigation and the results remain controversial. This study aimed to objectively assess the incidence and severity of complications following RAG vs. LAG using Clavien-Dindo (C-D) classification and to identify risk factors related to complications. METHODS Five hundred and twenty-seven patients with AGC who underwent RAG or LAG between January 2016 and May 2018 were enrolled in this study. Complications were categorized according to the C-D classification. The complications following RAG and LAG were compared using one-to-one propensity score matching (PSM) analysis and subgroup analyses. Logistic regression analyses were performed to identify risk factors related to complications. RESULTS RAG was performed in 251 patients (47.6%) and LAG in 276 patients (52.4%). Before PSM, the RAG group had a smaller tumour size (P = 0.004) and less patients with previous abdominal operation (P = 0.013). After PSM, a well-balanced cohort of 446 patients (223 in each group) was further analyzed. Of interest, the incidence of overall and severe complications (C-D grade ≥ IIIa) following the RAG group were significantly fewer than the LAG group (overall, 24.5% vs. 18.8%, P < 0.001; severe, 8.9% vs. 17.5%, P = 0.002). Subgroup analyses showed statistically significant difference were also observed in most stratified parameters. Multivariable analysis identified age ≥ 65 years, total gastrectomy, stage T3-T4a, stage II-III, and operation time ≥ 250 min as independent predictors of overall complications. Additionally, age ≥ 65 years, stage II-III, and operation time ≥ 250 min were confirmed as independent risk factors for severe complications. CONCLUSIONS RAG with D2 lymphadenectomy is feasible and safe for the treatment of AGC in terms of the lower incidence and severity of complications.
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Affiliation(s)
- Wen-Jie Wang
- Second Clinical Medical College, Lanzhou University, No. 82 Chuiying Gate, Chengguan District, Lanzhou, 730030, Gansu, People's Republic of China.,Department of General Surgery, Lanzhou General Hospital of Chinese People's Liberation Army, No. 333 Binhe South Road, Qilihe District, Lanzhou, 730050, Gansu, People's Republic of China
| | - Hong-Tao Li
- Second Clinical Medical College, Lanzhou University, No. 82 Chuiying Gate, Chengguan District, Lanzhou, 730030, Gansu, People's Republic of China.,Department of General Surgery, Lanzhou General Hospital of Chinese People's Liberation Army, No. 333 Binhe South Road, Qilihe District, Lanzhou, 730050, Gansu, People's Republic of China
| | - Jian-Ping Yu
- Second Clinical Medical College, Lanzhou University, No. 82 Chuiying Gate, Chengguan District, Lanzhou, 730030, Gansu, People's Republic of China.,Department of General Surgery, Lanzhou General Hospital of Chinese People's Liberation Army, No. 333 Binhe South Road, Qilihe District, Lanzhou, 730050, Gansu, People's Republic of China
| | - Lin Su
- Department of General Surgery, Lanzhou General Hospital of Chinese People's Liberation Army, No. 333 Binhe South Road, Qilihe District, Lanzhou, 730050, Gansu, People's Republic of China
| | - Chang-An Guo
- Second Clinical Medical College, Lanzhou University, No. 82 Chuiying Gate, Chengguan District, Lanzhou, 730030, Gansu, People's Republic of China.,Department of General Surgery, Lanzhou General Hospital of Chinese People's Liberation Army, No. 333 Binhe South Road, Qilihe District, Lanzhou, 730050, Gansu, People's Republic of China
| | - Peng Chen
- Department of General Surgery, Lanzhou General Hospital of Chinese People's Liberation Army, No. 333 Binhe South Road, Qilihe District, Lanzhou, 730050, Gansu, People's Republic of China
| | - Long Yan
- Department of General Surgery, Lanzhou General Hospital of Chinese People's Liberation Army, No. 333 Binhe South Road, Qilihe District, Lanzhou, 730050, Gansu, People's Republic of China
| | - Kun Li
- Department of General Surgery, Lanzhou General Hospital of Chinese People's Liberation Army, No. 333 Binhe South Road, Qilihe District, Lanzhou, 730050, Gansu, People's Republic of China
| | - You-Wei Ma
- Department of General Surgery, Lanzhou General Hospital of Chinese People's Liberation Army, No. 333 Binhe South Road, Qilihe District, Lanzhou, 730050, Gansu, People's Republic of China
| | - Ling Wang
- Second Clinical Medical College, Lanzhou University, No. 82 Chuiying Gate, Chengguan District, Lanzhou, 730030, Gansu, People's Republic of China
| | - Wei Hu
- Second Clinical Medical College, Lanzhou University, No. 82 Chuiying Gate, Chengguan District, Lanzhou, 730030, Gansu, People's Republic of China
| | - Yu-Min Li
- Second Clinical Medical College, Lanzhou University, No. 82 Chuiying Gate, Chengguan District, Lanzhou, 730030, Gansu, People's Republic of China.
| | - Hong-Bin Liu
- Second Clinical Medical College, Lanzhou University, No. 82 Chuiying Gate, Chengguan District, Lanzhou, 730030, Gansu, People's Republic of China. .,Department of General Surgery, Lanzhou General Hospital of Chinese People's Liberation Army, No. 333 Binhe South Road, Qilihe District, Lanzhou, 730050, Gansu, People's Republic of China.
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