Mesh Fixation Using Sutures May Result in a Reduction in Prolapse Recurrence after Laparoscopic Sacrocolpopexy in Patients with Vesicovaginal Adhesion

Abstract Objectives: Laparoscopic sacrocolpopexy (LSC) has long been considered the gold standard for treating pelvic organ prolapse. However, some patients experience prolapse recurrence even after LSC. The cause of prolapse recurrence may be multifactorial and is not completely elucidated. This study aimed to investigate the factors contributing to postoperative recurrence after LSC. Materials and Methods: The study enrolled 98 patients who underwent LSC at our hospital. Multiple logistic regression analysis and Cox proportional hazards analysis were conducted to evaluate the independent factors of prolapse recurrence. The Pearson Chi-square test was applied to examine the correlation between pre- and intraoperative factors and prolapse recurrence. Results: Based on the multiple logistic regression, the Cox proportional hazards model, and the correlation analysis, the presence of vesicovaginal adhesion was an independent factor of prolapse recurrence. Moreover, the number of sutures or tackers to the anterior vaginal wall (AVW), cervix, or vaginal vault (VV) might be correlated with prolapse recurrence. Patients with (1) vesicovaginal adhesion + two of (2) the number of sutures for mesh fixation AVW, (3) ≥3 tackers for mesh fixation to the AVW, and (4) ≤3 sutures for mesh fixation to the cervix or VV had a significantly shorter time to prolapse recurrence than those with two factors or less among (1) − (4). Conclusion: Firm fixation of the mesh to the vaginal wall or the cervix is essential to prevent prolapse recurrence in patients with vesicovaginal adhesion who are undergoing LSC.