Pelvic organ prolapse (POP) is a common connective tissue disorder that affects women mainly in their post menopausal age. The life time risk of requiring surgical repair is between 7% to 19% [1,2]. The  abdominal sacrocolpopexy is the most durable operation for advanced apical and multi-compartmental POP and serves as the benchmark against which other operations are compared.  It involves  attaching the vaginal apex or terminal cervix to the anterior longitudinal ligament of the sacrum with a synthetic mesh graft. Although the technique has been established since the 1970s not much has been documented in regards to its durability, safety and complications following surgery. Most series are limited to short term follow up. The reported incidence of recurrence in the E-CARE trial was estimated at 22-27% [3]. Furthermore there is no consensus on management for those who have failed an abdominal mesh sacrocolpopexy,  We report the outcomes from our series of revision mesh sacro-colpopexy.

A prospective review of consecutive patients from an IRB approved sacro-colpopexy database was performed. Patients with symptomatic pelvic organ prolapse whom underwent a revision mesh sacro-colpopexy (PCP) were analyzed. Data assessed included demographic characteristics, prior anti-incontinence/ genitourinary surgery, complications, validated questionnaires, POP-Q examination and associated outcomes.

Six patients underwent revision mesh sacro-colpopexy from November 2013 to April 2019 with at least 6 months follow up. Five patients (83%) had previous anti-incontinence surgery with mid urethral slings and hysterectomy. Mean age and follow up were 54.5 years (42-66) and 15 months (6-42) respectively. Mean time to failure from original surgery to revision surgery was 261 months (range 10.6-121). Three cases showed that the mesh had detached from the vaginal vault and/or sacral promontory. Mean preoperative C-point was -2 (2 to -8) compared to -11 (-12 to -10) postoperatively (p < 0.001). Mean operative time and blood loss were 270 minutes (210-360) and 107 ml (20-200) respectively. No patients developed recurrent vault prolapse. Post-operative functional outcome scores included QoL of 3.7 (range 1-10), UDI-6 of 5 (range 0-15), and IIQ-7 of 4.8 (range 1-10).

Although SCP is largely a durable and effective treatment for level one prolapse defects, revision surgery is often challenging, and half of the cases demonstrate mesh detachment. We recommend that these cases be done in a tertiary institution.

Revision mesh sacro-colpopexy was successful in all our cases without significant co-morbidities. All patients had good anatomical outcomes on follow up. However subjective functional outcomes were mixed reflecting the heterogenous patient population.

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Ingrid Nygaard  1 , Linda Brubaker, Halina M Zyczynski, Geoffrey Cundiff, Holly Richter, Marie Gantz, Paul Fine, Shawn Menefee, Beri Ridgeway, Anthony Visco, Lauren Klein Warren, Min Zhang, Susan Meikle. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013 May 15;309(19):2016-24.