Surgical outcome of abdominal sacrocolpopexy with synthetic mesh versus abdominal sacrocolpopexy with cadaveric fascia lata

Abstract

Nineteen women who had an abdominal sacrocolpopexy (ASC) with synthetic mesh and 18 women who had an ASC with freeze-dried, irradiated cadaveric fascia lata returned for blinded pelvic organ prolapse quantification (POPQ) examinations. The mean relative vaginal descent (delta) from perfect total vaginal length in the mesh group was 1.1 (0.3) cm, and the delta in the fascia group was 2.8 (0.8) cm (p=0.02, Mann-Whitney U). The proportion of women with "optimal" surgical outcome in the mesh group was 89% and 61% in the fascia group (p=0.06, Fischer's exact test). This study suggests that cadaveric fascia lata may not be a good choice for ASC.

Biologic Grafts and Synthetic Meshes in Pelvic Reconstructive Surgery

“…42 This is similar to a retrospective study that compared sacral colpopexy performed with FD-CFL (Community Tissue Services, Portland, OR) or synthetic mesh, Marlex (CR Bard, Cranston, RI) or Mersilene (Ethicon, Somerville, NJ), in 37 patients (19 synthetic mesh and 18 allograft) and found that 61% of patients in the allograft group had optimal outcome as compared with 89% of the patients in the synthetic mesh group with mean follow-up intervals of 21 and 26 months, respectively (P = 0.06). 43 There were no significant adverse events such as erosions from either group.…”

Cadaveric fascia lata

“…The investigators found a significantly higher failure rate in the allograft group (32%) vs the mesh group (9%, P=0.007). Gregory et al found similar anatomical failure rates when comparing mesh (Mersilene or Marlex) to allograft (freeze-dried, gamma-irradiated) [26]. Thus, the literature provides evidence that if given a choice between mesh and allograft in a sacrocolpopexy, in regard to anatomical outcomes, mesh is superior.…”

Treatment of pelvic organ prolapse

“…Allografts come from a human source other than the patient and may include cadaveric fascia or cadaveric dermis; to avoid the complication of vaginal erosion, some surgeons use cadaveric fascia instead of synthetic mesh, but this is associated with a higher rate of prolapse recurrence. 32 Xenografts are biological tissue obtained from a specie foreign to the patient, e.g. porcine dermis or bovine pericardium.…”