Efficacy And Safety Of Using Mesh Or Grafts In Surgery For Vaginal Wall Prolapse

OBJECTIVE To determine the effect and safety of mesh/graft for vaginalwall prolapse surgery.METHODS We searched The Cochrane Central Register of ControlledTrials(CENTRAL) PubMed EMbase CBMdisc CNKI VIP WANFANGDATABASE and web site of some clinical trials such as Clinical trials Currentcontrolled trials. Relevant journals were also hand searched to January2012.We collected randomized controlled trials (RCT) comparing mesh/graft forvaginal wall prolapse surgery with traditional colporrhaphy. Study selectionand quality assessment, data extraction and analyses were undertaken by tworeviewers independently according to the Cochrane Handbook for SystematicReviews of interventions. Meta-analyses were also performed.Results:18studies involving and2443patients were included. Based onthe trial reports.1. The objective prolapse recurrence rate:(1). In anterior repair,there was short-term evidence that mesh/graft (any type) can reduced objectiveprolapse recurrence rates compared with no mesh/graft. Among them,nonabsorbable synthetic mesh group compared with traditional colporrhaphy group (relative risk0.15,95%CI0.11–0.21), biological graft group comparedwith the traditional colporrhaphy group (relative risk0.44,95%CI0.29–0.68)and absorbable synthetic mesh group compared with traditional colporrhaphygroup (relative risk0.48,95%CI0.26–0.87). Compared the recurrence ratebetween nonabsorbable synthetic mesh group (13.1%,54/413) with biologicalgraft group (15.8%,46/292), there were no significantly different.(2). Inposterior repair, there was no evidence that surgery adding mesh/graft(absorbable synthetic and biological graft) can reduced objective prolapserecurrence rates compared with traditional posterior colporrhaphy.(3). Inanterior+posterior repair, there was short-term evidence that surgery addingnonabsorbable synthetic mesh can reduced objective prolapse recurrence ratescompared with traditional anterior and posterior colporrhaphy (relative risk0.33,95%CI0.12–0.85), when absorbable synthetic mesh can not.2. The subjectivesymptoms: In the studies, mesh/graft were no advantage in improve thesubjective symptoms compared with no mesh/graft.(3) Complications andadverse events: some evidence to support the trends that damage to surroundingorgans,de novo urinary symptoms,reoperation a higher rate occurred in thenonabsorbable synthetic mesh group than in the no mesh/graft group.nonabsorbable synthetic mesh have a higher erosion rate (8.32%52/625) thanabsorbable synthetic mesh (0.87%1/115) and biological graft (2.33%9/387).CONCLUSION1. there was short-term evidence that, In anterior repair,surgery adding nonabsorbable synthetic mesh and biological graft have a lowerobjective prolapse recurrence rate than the traditional colporrhaphy, andnonabsorbable synthetic have a better effect than biological graft. whencompared to the traditional group, there was no advantage in improve thesubjective symptoms in mesh group.2. In anterior+posterior repair, using nonabsorbable synthetic mesh can reduced objective prolapse recurrence rateswhen compared with conventional colporrhaphy, but there was no advantage inimprove the subjective symptoms3. In posterior repair, there was no Significantdifferences recurrence rates and subjective symptoms when comparedconventional posterior colporrhaphy with surgery adding absorbable synthetic orbiological graft4. nonabsorbable synthetic mesh have a higher erosion rate thanabsorbable synthetic mesh and biological graft.5. some evidence to support thetrends that damage to surrounding organs,de novo urinary symptoms,reoperationa higher rate occurred in the nonabsorbable synthetic mesh group thantraditional colporrhaphy group.