Jim W Ross1. 1. Center for Female Continence, Salinas, California 93901, USA. ctrreprodmed@sbcglobal.net
Abstract
STUDY OBJECTIVE: To assess the efficacy of a xenogenic barrier in preventing vaginal mucosal erosion and the use of a collagen-coated polypropylene mesh in preventing small bowel obstruction with laparoscopic sacrocolpopexy for the treatment of severe vaginal prolapse. DESIGN: Prospective longitudinal study (Canadian Task Force classification II-1). SETTING: Private urogynecology clinic. PATIENTS: A total of 31 consecutive post-hysterectomy patients with severe apical vaginal prolapse (pelvic organ prolapse quantification [POP-Q] stages 2-4). INTERVENTIONS: Laparoscopic sacrocolpopexy, in conjunction with other laparoscopic and/or vaginal procedures, was used to correct pelvic floor disease. A Y-shaped polyester multifilament mesh, with a resorbable collagen coating, was used for the implant. The inner surfaces of the Y-shaped synthetic mesh had porcine dermal strips attached to act as a buffer/barrier for the vaginal wall. MEASUREMENTS AND MAIN RESULTS: A total of 29 (94%) of 31 patients were cured at 12 months (defined as POP-Q < stage II). There were no more failures in the 28 patients followed-up at 24 months. Two patients had recurrent apical prolapse (Point C = -1 and 0). There were no small bowel obstructions and no vaginal mesh erosions during the 2-year follow-up. There was significant improvement in the sexual and quality of life questionnaires after repair. CONCLUSION: Laparoscopic sacrocolpopexy is an effective treatment for apical vault prolapse. There were no cases of vaginal erosion in the first 2 years of follow-up with the "combination" biosynthetic mesh. It is suggested that the interposition of a collagen barrier between the synthetic mesh and the vaginal mucosa prevents erosion. Biosynthetic engineering appears promising in aiding the prevention of the most common complication in pelvic floor reconstructive surgery with permanent implants. The use of permanent synthetic mesh plays an important role in the success of sacrocolpopexy, removing the dependence on the use of poor in situ tissue seen in classic and site-specific repairs. The use of biologic barriers developed specifically for certain actions may be useful in minimally invasive vaginal repair surgery.
STUDY OBJECTIVE: To assess the efficacy of a xenogenic barrier in preventing vaginal mucosal erosion and the use of a collagen-coated polypropylene mesh in preventing small bowel obstruction with laparoscopic sacrocolpopexy for the treatment of severe vaginal prolapse. DESIGN: Prospective longitudinal study (Canadian Task Force classification II-1). SETTING: Private urogynecology clinic. PATIENTS: A total of 31 consecutive post-hysterectomy patients with severe apical vaginal prolapse (pelvic organ prolapse quantification [POP-Q] stages 2-4). INTERVENTIONS: Laparoscopic sacrocolpopexy, in conjunction with other laparoscopic and/or vaginal procedures, was used to correct pelvic floor disease. A Y-shaped polyester multifilament mesh, with a resorbable collagen coating, was used for the implant. The inner surfaces of the Y-shaped synthetic mesh had porcine dermal strips attached to act as a buffer/barrier for the vaginal wall. MEASUREMENTS AND MAIN RESULTS: A total of 29 (94%) of 31 patients were cured at 12 months (defined as POP-Q < stage II). There were no more failures in the 28 patients followed-up at 24 months. Two patients had recurrent apical prolapse (Point C = -1 and 0). There were no small bowel obstructions and no vaginal mesh erosions during the 2-year follow-up. There was significant improvement in the sexual and quality of life questionnaires after repair. CONCLUSION: Laparoscopic sacrocolpopexy is an effective treatment for apical vault prolapse. There were no cases of vaginal erosion in the first 2 years of follow-up with the "combination" biosynthetic mesh. It is suggested that the interposition of a collagen barrier between the synthetic mesh and the vaginal mucosa prevents erosion. Biosynthetic engineering appears promising in aiding the prevention of the most common complication in pelvic floor reconstructive surgery with permanent implants. The use of permanent synthetic mesh plays an important role in the success of sacrocolpopexy, removing the dependence on the use of poor in situ tissue seen in classic and site-specific repairs. The use of biologic barriers developed specifically for certain actions may be useful in minimally invasive vaginal repair surgery.
Authors: Colleen D McDermott; Jean Park; Colin L Terry; Patrick J Woodman; Douglass S Hale Journal: Int Urogynecol J Date: 2010-10-20 Impact factor: 2.894
Authors: Jasmine Tan-Kim; Shawn A Menefee; Karl M Luber; Charles W Nager; Emily S Lukacz Journal: Int Urogynecol J Date: 2010-09-15 Impact factor: 2.894