Impact of Previous Pelvic Organ Prolapse Repair on Outcomes of Robotic-assisted Mesh Sacrocolpopexy.

Abstract

<h4>Objective</h4>To assess the impact of previous pelvic organ prolapse (POP) surgery on the outcomes of robotic-assisted mesh sacrocolpopexy (RASC) in posthysterectomy women.<h4>Methods</h4>Following IRB approval, a retrospective review of a prospectively-followed cohort of posthysterectomy women who underwent a RASC for symptomatic multicompartment prolapse was performed by an investigator not involved in the clinical care of these patients. The cohort was stratified based on history of prior POP repair, as first line repair (FR) and second line repair (SR). Success was defined by a composite of no report of recurrent vaginal bulge, no prolapse beyond the hymen on examination, and no retreatment for prolapse. Secondary outcomes included additional surgeries for prolapse, Clavien-Dindo perioperative complications, and Kaplan-Meier time interval to recurrent prolapse surgery.<h4>Results</h4>Between 2010 and 2020, 87 patients underwent RASC; 35 as FR and 52 as SR. Demographics were similar in each group. Overall, all three components of success definition were met by 82% of patients (29/35) in FR group, and 73% (38/52) in the SR group (P = .31) at median follow-up of 42 (range: 20-81) months and 61 (range: 22-116) months, respectively. Additional POP surgery was performed on 6% in the FR group and 12% in the SR group (P = .3). Grade ≥2 complications were significantly more frequent in the SR group, with 12 cases, compared to two cases in the FR group (P = .04).<h4>Conclusion</h4>A history of prior POP repair was not significantly associated with an increased POP recurrence rate after RASC, but had a higher perioperative morbidity.