Zhang CY, Sun ZJ, Yang J, Xu T, Zhu L, Lang JH. Sacrocolpopexy compared with transvaginal mesh surgery: a systematic review and meta-analysis.
BJOG 2020;
128:14-23. [PMID:
32426903 DOI:
10.1111/1471-0528.16324]
[Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND
The use of mesh is controversial in the treatment of female pelvic organ prolapse.
OBJECTIVES
To systematically review the outcomes of sacrocolpopexy compared with transvaginal mesh surgery and to provide evidence-based suggestions.
SEARCH STRATEGY
The MEDLINE, EMBASE, Cochrane Library and clinicaltrials.gov databases were searched on 21 November 2018.
SELECTION CRITERIA
Randomised controlled trials and prospective and retrospective cohort studies were included.
DATA COLLECTION AND ANALYSIS
Data were extracted by one reviewer and examined by a second reviewer for accuracy. Odds ratios and 95% CI were calculated using random-effects models.
MAIN RESULTS
Twenty comparative studies were included. The meta-analysis was performed with subgroups. The summary odds ratios of the randomised controlled group were 1.84 (95% CI 0.79-4.29, I2 = 75%) for anatomical success, 1.41 (95% CI 0.47-4.24, I2 = 38%) for subjective success, 0.42 (95% CI 0.18-0.98, I2 = 0%) for mesh complications, 0.61 (95% CI 0.20-1.91, I2 = 0%) for prolapse reoperation and 0.44 (95% CI 0.23-0.88, I2 = 0%) for de novo dyspareunia. The mean differences were 0.77 (95% CI 0.31-1.23, I2 = 66%) for total vaginal length and -1.28 (95% CI -2.00 to -0.55, I2 = 66%) for point C after surgery.
CONCLUSIONS
Very-low-quality evidence indicated that the anatomical and subjective success rates of sacrocolpopexy were similar to those of transvaginal mesh surgery; sacrocolpopexy might be more beneficial than transvaginal mesh surgery in terms of mesh-related complication rates, prolapse recurrence and de novo dyspareunia. However, additional high-quality randomised trials with long-term follow-up durations are needed.
TWEETABLE ABSTRACT
Sacrocolpopexy is beneficial after surgical anatomical changes and has decreased rates of mesh-related complications and dyspareunia.
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