Abstract
Aim of the review: Initial use of synthetic mesh in pelvic organ prolapse surgery involved use of custom made meshes. Custom made mesh involves cutting of a synthetic mesh into appropriate size and shape, and anchoring the mesh to the supporting structures using sutures. On the other hand, there are varieties of pre-designed commercially available mesh kits attached with trocars for insertion of mesh. This review aims to analyze the success rates, complications, and viability of custom made meshes and compare them with pre-designed mesh kits.
Methods of literature search and analysis: A Pubmed search for the term “Vaginal mesh” revealed 1421 articles. Further narrowing the search using filters “Last 10 years”, “Humans” and excluding “Review articles”, we obtained 850 papers on vaginal mesh. Searching through these 850 papers, we found that 89 papers dealt with customised mesh in pelvic floor surgery. Papers are analyzed under the sub-headings efficacy in anterior and apical compartment, complications, comparison of custom mesh with predesigned mesh kits, and abdominal mesh repairs.
Results: In the anterior compartment, anatomical failure rate for custom mesh is around 17%, and that of subjective failure rate is around 4.4%. In the Apical compartment repair, anatomic failure rate for customized mesh for apical compartment ranges from 0% to 7%. The risk of vaginal exposure for custom mesh ranges from 5 to 17%. New onset of dyspareunia was noted in 4.5% to 16.7% of patients. In terms of efficacy, custom mesh gives equally good success comparable to that of pre-designed mesh kits. Complication rates are similar between custom meshes and pre-designed mesh kits, with the exception of reduced blood loss in custom meshes. Customised meshes are relatively inexpensive compared to predesigned mesh kits.
Conclusion: In terms of efficacy, customised mesh gives equally good success rates for pelvic organ prolapse surgery as compared to pre-designed mesh kits, with an added advantage of reduced cost. This is particularly relevant in developing countries where cost of surgery is of paramount importance for patients. Other advantage of custom made mesh kits is reduced blood loss.
Keywords: Complications, cost-effectiveness, pelvic organ prolapse, vaginal mesh.
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