Readmission and Prolapse Recurrence After Abdominal and Vaginal Apical Suspensions in Older Women

摘要

Optimal surgical approaches for pelvic organ prolapse have been investigated in randomized controlled trials and systematic reviews, but the safest and most durable apical suspension has not been definitely identified. Estimates of prolapse recurrence vary widely (from 2.3% to 29.2%) because of differences in study design and length of follow-up. Systematic reviews suggest that use of abdominal sacrocolpopexy with synthetic mesh provides better anatomic outcomes and more durable repair than vaginal apical suspensions; however, sacrocolpopexy is associatedwith higher rates of gastrointestinal, mesh, suture, and thromboembolism complications. Recent studies have reported greater morbidity and higher mortality after surgical prolapse treatment in older women, suggesting that the benefits of abdominal sacrocolpopexy with synthetic mesh in this population may not outweigh the risks of surgical complications.