Predictors of exposure to pelvic organ prolapse after transvaginal mesh placement(TVM)forpelvic floorreconstruction
Objective Toanalyze the predictive factors of mesh exposure after pelvic floor reconstruction surgery with transvaginal mesh placement.Methods Retrospective analysis of clinical data of 94 patients with pelvic organ prolapse who received transvaginal mesh placement(TVM)treatment in the obstetrics and gynecology department of the hospitalfrom October 2019 to September 2022,including age,medical history,pelvic floor/uterine surgery history,degree of prolapse,mesh type,concurrent surgical condi-tions,incision suturing method and operator experience.According to the patient's incision suture meth-od,thepatientswere divided into a vaginal wall overall suture group and a submucosal suture group.The Kaplan-Meier method was used to plot the proportion time curve of non mesh exposure in patients with different incision sutures,and the Log-rank test was used to compare the occurrence of mesh exposure be-tween the 2 groups of the patients.Univariate and multivariate Cox proportional hazard regression were used toanalyze the predictorsof mesh exposure and the corresponding risk ratios.Results As of September 30,2023,15(16.0％)patients experienced mesh exposure.Kaplan-Meier survival analysis showed that there was a significant difference in the cumulative mesh exposure ratio between the 2 groups(Log rank test x2=5.521,P=0.019).The Cox proportional risk analysis of multiple factors including incision suture mode and age,birth times(defined as a binary variable according to ≥3 and＜3),diabetes history,smok-ing history,vaginal pelvic floor surgery history,mesh system type,whether to combine hysterectomy and operator experience showed that incision suture mode and age,diabetes history and operator experience were independent predictors of mesh exposure,among which,the risk ratio of vaginal wall overall suture mode to submucosal suture mode to mesh exposure was 4.201,95％CI range is 1.247～14.155,Wald's x2=5.363,P=0.021.Conclusion For TVM placement-based pelvic reconstructive surgery,different in-cision suturing methods have a significant and surgeon experience-independent impact on the risk of post-operative mesh exposure.The adoption ofsubmucosal suturing method for the closure of incision is likely more helpful in avoiding mesh exposure compared with integrated vaginal wall suturing.
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