Analysis Of Recurrent Cases After Pelvic Floor Reconstruction With Mesh

Objective:To explore the risk factors related to the recurrence of pelvic floor reconstructive surgery,preventive measures and the treatments after recurrence to guide the clinical work.Method:A retrospective analysis was carried out on the clinical datas of 7 patients who underwent a secondary pelvic reconstructive surgery for recurrent pelvic floor dysfunction in Dalian maternity hospital Affiliated Hospital of Dalian Medical University gynecology from March 2008 to November 2016.Results:In 7 cases,the course of disease ranged from 5 to 12 years with an average of(8.6±2.37)years,the follow-up time ranged from 30 to 108 months with an average of(78.4 ± 29)months,the age of the first operation ranged from 57 to 73 years old with an average of(62 ± 5.7)years old,the age of the second operation ranged from 57 to 73 years old with an average of(62 ± 5.7)years old.The risk factors for recurrence:they were all elderly postmenopausal women,the age of menopause ranged from 41 to 57 years with an average age of(49 ± 5.4)years old,the time of menopause ranged from 3 to 25 years with an average of(13 ± 9.1)years,they were all not under hormone replacement therapy,the pregnancy time ranged from 1 to 4 times with an average of(3.3 ± 1.1)times,the production time ranged from 1 to 3 times with an average of(1.6 ±0.8)times,they were all vaginal delivery,constipation 42.9%(3/7),they all had vaginal compression feeling,hypertension 71.4%(5/7),diabetes mellitus 28.6%(2/7),Stress Urinary Incontinence 57.1%(4/7),myasthenia gravis 14.3%(1/7),umbilical hernia 14.3%(1/7).The first operation for Case One was vaginal hysterectomy,repair of anterior vaginal wall(with mesh)and repair of posterior wall of vagina,the recurrent time was 7 months after operation,then she underwent the repair of posterior wall of vaginaoperated for the recurrence of posterior vaginal prolapse in the 8 months after the first operation.The first operation for Case Two was total pelvic floor reconstruction(preserving uterus)and tension-free vaginal tape-obturator(TVT-0),the recurrent time was 38 months after operation,then she underwent the laparoscopic total hysterectomy,bilateral adnexectomy and sacrocolpopexy(with mesh)for the recurrence of uterine prolapse in the 44 months after the first operation.Case Three once had vaginal hysterectomy,the first pelvic floor operation was total pelvic floor reconstruction,the recurrent time was 2 months after operation,then she underwent the high ligation of hernial sac and anterior pelvic reconstruction for the recurrence of vaginal vault prolapse in the 12 months after the first pelvic floor operation.The first operation for Case Four was repair of anterior vaginal wall(with mesh),the recurrent time was after operation,then she underwent the TVT-O for the SUI in the 24 months after the first operation.The first operation for Case Five was repair of anterior vaginal wall(with mesh)and TVT-O,the recurrence time was 18 months after operation,then she underwent the vaginal hysterectomy for the recurrence of uterine prolapse in the 24 months after the first operation.The first operation for Case Six was repair of anterior vaginal wall(with mesh),the recurrent time was 49 months after operation,then she underwent the vaginal hysterectomy for the recurrence of uterus and posterior vaginal prolapse in the 51 months after the first operation.The first operation for Case Seven was total pelvic floor reconstruction(preserving uterus),the recurrent time was 6 months after operation,then she underwent the vaginal hysterectomy and repair of anterior vaginal wall for the recurrence of uterus and anterior vaginal prolapse in the 54 months after the first operation.Satisfactory results were both obtained after the two operations.Conclusion:The incidence rate of undergoing the secondary operation after pelvic floor reconstruction with mesh is 1.7%in our data.Old age,vaginal delivery,production time,menopause,high degree of prolapse,comorbidities,constipation,inadequate preoperative evaluation,incorrect selection of operation,poor surgical procedures,the inaccurate placement and fixation of the mesh and so on are all the risk factors of recurrence after operation.The choice of surgical methods after recurrence should be considered in many ways.Only the development of appropriate individualized treatment program,in order to achieve the best therapeutic effect.