CONSERVATIVE CARE AND OUTPATIENTMESH EXPOSURE EXCISION AFTER TRANSVAGINAL MESH PROLAPSE REPAIR
C. ASUMPINWONG1, P.LEERASIRI 2, P. HENGRASMEE 3;
1Obstetricand Gynecology, Siriraj Hosp., Mahidol Univ., Bangkok, Thailand,2Siriraj Hosp., Mahidol Univ., Bangkok, Thailand, 3Dept.ofO&G, Faculty of Med., Siriraj Hosp., Bangkok, Thailand.
Introduction: The use ofprosthetic mesh can improve efficacy of the pelvic organ prolapsesurgery. However, there are some concerns about its complications.Vaginal mesh exposure is the most common post-operative complication.Nowadays, no consensus have addressed the management of thiscomplication. Moreover, previous studies about conservativemanagement are very limited.
Objective: To evaluatesymptomatic outcome of conservative treatment and/or outpatient meshexposure excision, size of exposed mesh and patientsatisfaction.
Methods: This is a retrospective chart reviewof all women who developed vaginal mesh exposure following anteriormesh augmentation at our Urogynecology unit between January 2009 andJuly 2016. The patients were treated with conservative therapy oroutpatient trimming of exposed mesh. Symptoms, size of exposed meshand POP-Q examinations at each follow-up visit were recorded.Patients were asked about their satisfaction, need for surgicaltreatment and impact of quality of life by telephone interview orduring follow-up visit. A p-value of less than 0.05 wasconsidered statistically significant.
Results: Data from 53women with mesh exposure were collected; 24 were observed, 15 weretreated with conservative management, and 14 received trimming ofexposed mesh. The mean follow-up was 13.49 months. 9 patients hadsymptoms prior to treatment and symptoms disappeared in 6 patientsafter observation or conservative treatment. Unfortunately, 3patients had persistent symptoms and 7 patients developed newsymptoms after treatment. No patient had complete epithelialization.Furthermore, there was an increased trend of exposed mesh size overthe follow-up period (r=+0.03, p<0.001). However, theexposed mesh had little effect to quality of life. Almost allpatients were satisfied with the conservative treatment for vaginalmesh exposure. Only 1 patient with partner dyspareunia needed othersurgical intervention.
Conclusions: Women who received theconservative treatment for vaginal mesh exposure may have newsymptoms or increase in size of exposed mesh. However, patientsatisfaction was quite high.
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