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Common pelvic surgery disappoints



A common type of gynecologic surgery, often performed to repair damage caused by childbirth, fails nearly one-third of patients within seven years, new research shows.

The surgery aims to correct pelvic organ prolapse, which occurs when organs such as the uterus, bladder or rectum drop out of place, typically because their supporting muscles and ligaments have become too weak or stretched out.

About one in four women suffer either prolapse or incontinence at some point, and studies show that 11% to 19% of women have surgery for it.

Doctors found that the "gold standard" prolapse surgery, a procedure called abdominal sacrocolpopexy, often fails to relieve symptoms of prolapse, which can cause discomfort and difficulty voiding, according to a study published in May in the Journal of the American Medical Association.

In this surgery, doctors use tissue or synthetic mesh to attach the top of the vagina to a ligament in the lower back, says Ingrid Nygaard, a professor of obstetrics and gynecology at the University of Utah School of Medicine and lead author of the study, which followed 215 women for about seven years.

In that time, nearly one in three women saw their symptoms return or had their pelvic organs slip out of place again, the study says. About 17% needed additional pelvic surgery within seven years, the study says.

In about one in 10 women, the mesh protrudes through tissue, which can cause inflammation and bleeding, Nygaard says.

The surgery's effectiveness at relieving prolapse symptoms decreases over time, Nygaard says. Still, "most women will report fewer bothersome symptoms than they did before surgery," Nygaard says.

About 225,000 pelvic prolapse surgeries are performed in the USA each year, Nygaard says.

The new study is the first time researchers have followed women long term, says Gunhilde Buchsbaum, a professor at the University of Rochester Medical Center, who wasn't involved the new study.

Many surgical repairs eventually fail, says Cheryl Iglesia of the Georgetown University School of Medicine: 28% of abdominal hernias recur within five years of surgery.

Like other repairs, pelvic surgery "may be vulnerable to the normal wear and tear of aging and activities of daily living," Iglesia writes. Or, as Nygaard says, "things start to sag."

Iglesia says it's possible that women may fare better in the future, because surgeons today use a different type of surgical mesh, which appears to cause fewer complications. Still, she says doctors need to talk about "managing" prolapse, rather than curing it.

Nygaard says doctors need to make the risks of surgery clear when counseling patients.

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