Evolution of biological and synthetic grafts in reconstructive pelvic surgery

Abstract

Surgery is an evolving science in the attempt to make surgical procedures more effective, safer, and less invasive. Recurrence and subsequent re-operation for stress incontinence and prolapse has been reported to be necessary in one of three patients, so there is a need for improvement [1]. In reconstructive pelvic surgery (RPS), the use of biological and synthetic grafts for the transabdominal and transvaginal treatment of pelvic organ prolapse (POP) or stress urinary incontinence (SI) has improved long-term support and function after surgery. However, the potential benefits of using grafts need to be carefully balanced against the risks of using materials foreign to the patient's body. Pelvic organ prolapse develops secondary to defective endopelvic fascial and muscular support. The levator ani provides resting tonic muscular support for all three pelvic compartments. Once neuromuscular damage occurs, extra strain is placed on the connective tissue supports, which may also subsequently fail. To date, there is no surgery that adequately addresses the issue of neuromuscular damage of the pelvic floor musculature. In conventional POP surgery, defective support is repaired by suturing of the patient's own connective tissue, fascia, or ligaments. The rationale for the use of grafts is to reinforce and strengthen pelvic organ repairs similar to the use of grafts to strengthen abdominal hernia repair.

Experience with a cell engineering construction for the surgical treatment of pelvic prolapse: A preliminary communication

“…В качестве клеточного материала в зару-бежной практике используются мезенхимальные стволо-вые клетки, а также фибробластоподобные клетки [20]. Получение данных культур клеток связано с большими техническими сложностями [21].…”

The biochemistry of wound healing in the pelvic floor: What have we learned?

“…Other polymers (eg, polyester) also have been used. They cause more foreign body reaction and more wound-healing complications, at least in hernia patients [43].…”

Augmented repairs and use of interposition grafts in pelvic reconstructive surgery: Part I

“…Although the exact pathogenesis of recurrent pelvic organ prolapse remains uncertain, factors thought to play an important role include the poor quality of the patient's own tissues, deficient postoperative wound healing, chronic diseases manifesting with persistently elevated intra-abdominal pressure (obesity, constipation, or chronic obstructive pulmonary disease), poor patient selection, inappropriate choice of suture material, lack of surgical expertise, and deficient surgical technique [3•,6]. Thus, because of what is perceived among pelvic floor reconstructive surgeons as an unacceptably high failure rate, synthetic and biologic interposition grafts have been introduced as a means to reinforce and strengthen surgical repairs of pelvic organ prolapse [7].…”