Comparison of vaginal hysterectomy and tension-free vaginal mesh surgery for pelvic organ prolapsus: review of the first 20 operations performed by a first-time surgeon

Objective. To review and compare the first 20 cases of vaginal hysterectomy (VH) and tension-free vaginal mesh (TVM) surgery for pelvic organ prolapsus (POP) performed by a first-time surgeon. Method. Operation time, anesthesia time, intraoperative bleeding volume and number of postoperative days in hospital were compared among the first 20 patients who underwent VH surgery or TVM surgery. Results. Operation time was 113.65±29.44 min in the VH group and 88.70±22.65 min in the TVM group, with the latter being significantly shorter. Anesthesia time was also significantly shorter in the TVM group. Intraoperative bleeding volume was ≤30 mL in 1 patient in the VH group, while the mean of the remaining 19 patients was 133.68±83.81 mL. In the TVM group, 14 patients had bleeding volumes of ≤30 mL, with the mean among the remaining 6 patients being 44.67±24.67 mL. The mean number of postoperative days in hospital was 13.3±3.6 days in the VH group and 5.6±2.64 days in the TVM group. When the first 20 patients treated by each surgical technique were divided into the first 10 and second 10 cases, operation and anesthesia times were significantly shortened in the second 10 cases compared with the first 10 cases in the VH group, but no significant differences were observed in the TVM group. Conclusion. TVM surgery should be considered as a first-line treatment for patients with POP since it is relatively easy to perform compared with conventional operations. Surgeons intending to perform TVM surgery, however, should have a full understanding of pelvic anatomy and POP status and receive instruction from experienced surgeons before progressing to practical training.