A Systematic Review of Graft-Related Complications and Recurrence Following Minimally Invasive Sacrocolpopexy With Xenografts and Allografts

BACKGROUND: Biological grafts are proposed as an alternative to synthetic grafts in sacrocolpopexy (SC) to reduce complications such as graft exposure and immunologic reactions. However, concerns remain long-term durability. This systematic review and meta-analysis assess recurrence rates and graft-related complications (GRC) in minimally invasive sacrocolpopexy (MISC) using biological grafts.

OBJECTIVES: To evaluate the recurrence and GRC following MISC with biological grafts and to compare outcomes across different materials.

SEARCH STRATEGY: PubMed, Embase and Cochrane databases were searched up to August 2024.

SELECTION CRITERIA: Studies with ≥ 10 patients undergoing MISC with biological grafts, reporting recurrence or GRC with ≥ 6 months follow-up, were included.

DATA COLLECTION AND ANALYSIS: Two independent reviewers assessed study quality using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis estimated pooled recurrence and GRC with 95% confidence intervals (CI).

MAIN RESULTS: Five studies (353 patients) met inclusion criteria. Recurrence rates ranged from 2.4% to 52.6% (pooled: 25.6% [95% CI: 8.1%-48.2%]). Graft exposure occurred in 0.8% (95% CI: 0.0%-4.2%). ADM had the lowest recurrence (2.4%) with no reported exposures, whereas Tutoplast cadaveric fascia lata showed the highest recurrence (52.6%) and exposure (5.3%). The pooled reoperation rate for recurrence was 16.8% (95% CI: 0.0%-51.7%).

CONCLUSION: This systematic review identified a higher recurrence rate with biological grafts in MISC than typically reported for synthetic grafts in other literature, while exposure rates appeared to be comparable. Given study heterogeneity, further research is required to determine the optimal graft choice balancing durability and complication risk.