Anterior compartment prolapse repair with a hybrid biosynthetic mesh implant technique

Abstract

The aim of the present study is to assess the safety and feasibility of a new technique for cystocele repair using a hybrid biosynthetic graft fixed by the transobturator approach. This is a retrospective study of 13 women diagnosed with symptomatic anterior compartment prolapse that were in stages II and IV, using Pelvic Organ Prolapse Quantification score and treated between 2003 and 2006. The surgical procedure was carried out through a vaginal approach, exposing the arcus tendineus and the posterior surface of the obturator foramen from the ischial spine to the inferior pubic ramus bone. The patients were followed-up after 3, 6 and 12 months. The anatomical cure rate was 85% (stage 0), although two patients had a recurrence 8 months after surgery. All patients would repeat the procedure, if necessary. No de novo dyspareunia was observed in these small series. The results suggest that this technique is safe and feasible and is a comprehensive surgical approach for anterior compartment prolapse, without postoperative morbidity.

Transvaginal cystocele correction: Midterm results with a transobturator tension‐free technique using a combined bovine pericardium/polypropylene mesh

“…Our midterm postoperative results showed good rates of prolapse cure (91.7%), higher than those for dermal porcine meshes (81%, follow up 14 months and 85%, follow up 12 months), 23,24 but still lower than those presented by Meschia (93%; 12 months) and Leboeuf (93.1%; 15 months) 8,37 . However, our patients received a longer period of follow up (35 months, range 21–43), further increasing the significance of our data.…”

“…Furthermore, in more recent studies different authors created a hybrid implant containing a middle section (for the correction of the central defect) and around the edges consisting of four synthetic ‘legs’ (for the correction of the lateral defects), providing a greater stability of the mesh to the pelvic walls. Eighty‐five percent of patients affected by stage III and IV anterior compartment prolapse were cured using these new combined prostheses 24 …”

“…Eight types of xenograft materials are commercially available at this moment in time, all differing according to a number of factors: the species from which they were derived (bovine or porcine), the site of collagen harvest (pericardium, dermis, or small intestine submucosa), the sterilization process (chemical or radiation), and whether or not chemical cross‐linking was used during the manufacturing process 17–19 . Good results were reported for the treatment of complicated abdominal wall hernias, 20–22 and several studies have also been conducted in gynecological pelvic floor surgery 23–28 …”

Double Transobturator Approach to Treating Cystocele

“…But, on the other hand, the absence of "cross linking" between its fibres prevents fibroblastic and vascular colonization, so the mesh does not integrate into the host tissue but is encapsulated by it. [7] This involves a lower fixity of the porcine derma to the anatomical structures of the pelvis, so recurrence is more frequent. Because of these considerations the use of porcine derma has been reserved to ≤ II grade prolapse.…”

Quoi de neuf depuis le rapport de la HAS ? Bilan de deux ans d’évaluation des implants de renfort prothétique dans le traitement des prolapsus par voie vaginale

“…Les séries rétrospectives relatent des taux d'expositions de 0 % pour Robles et al à 30 % pour Lim et al [42,45]. Dans la série de Lim et al [45], le matériau était une prothèse composite de Vypro ® principalement en traitement de la rectocèle et suturée latéralement par fil résorbable.…”