Analysis of the learning curve of bilateral anterior sacrospinous ligament suspension associated with anterior mesh repair

Abstract

Objective: To analyze the learning curve of bilateral anterior sacrospinous ligament suspension associated with anterior mesh repair in a single center.

Study design: The first 113 bilateral anterior sacrospinous ligament suspensions associated with anterior mesh repair performed by three surgeons trained together in a single center were analyzed retrospectively for pre-operative, operative and post-operative data. To discover a turning point, all major complications were reported and the study population was divided into five groups of approximatively 22 interventions each, classed chronologically. Statistical analysis was carried out by the Cochran-Armitage trend test and Cox proportional hazards models. Other descriptive statistics were computed with the use of standard methods for means and proportions.

Results: Of the 103 evaluable patients (91.2%), the success rate for both anterior and apical compartments was 87.4%. The rate of major post-operative complications was 7.2% (8/111). Statistical analysis showed that the risk of major complications was reduced by approximately 30% every ten procedures (HR=0.71, 95% CI: 0.53-0.95). Success rate, operative time and hospital stay remained unchanged throughout the series. Mesh exposure rate was 3.6%.

Conclusion: Bilateral anterior sacrospinous ligament suspension associated with anterior mesh repair was associated with a learning curve to decrease the rate of major complications.