BACKGROUND: Transvaginal synthetic mesh placement for correction of pelvic floor prolapse and vaginal compartment defects has been shown to be safe as well as highly successful with minimal risk and low complications in the short term. We present our 2 year results of this technique using the Prolift (Ethicon) extraperitoneal sacrocolopexy (EPS) mesh.
METHODS: Trocar guided transobturator EPS was performed in 174 patients. The patients ranged in age from 28 to 85 yrs. Fifty three anterior, forty five posterior, and seventy six combined repairs were performed. A concurrent mid-urethral sling was placed in 89.1% (155/174) cases. An EPS was performed for defects Grade II or higher. In 30 patients there was documented Grade II or greater uterine prolapse, none requiring simultaneous hysterectomy.
RESULTS: Overall operative time decreased from an average of 67 min for the first 65 cases to 45 min for the last 110 cases. Operative times decreased from an average of 47 min to 25 min for a single compartment repair, 59 min for a single compartment and mid-urethral sling to 39 min, and 94 min for a combined repair with mid-urethral sling to 47 min during the same period of measurement. An incidental cystotomy occurred in 10 (7.8%) of anterior and combined EPS cases. All were repaired primarily without sequelae. There werre no complications is the posterior EPS group. Only 1 patient required a blood transfusion. Of the 30 patients with uterine prolapse treated by combined EPS, 4 (13.3%) developed recurrent prolapse. There were an additional 3/144 (2.1%) cases of recurrent prolapse, 2 Grade III cystoceles, and one Grade III enterocele. Follow-up out to 22 months indicated only 3/174 (1.7%) cases of mesh erosion; all treated by surgical excision of only the exposed mesh along with primary tissue closure.
CONCLUSIONS: Intermediate results at 24 months for trocar guided transobturator EPS for primary repair of vaginal compartment herniation reveal a low complication rate with high success. EPS for uterine prolapse is an acceptable alternative to hysterectomy in selected patients, preserving 86.7% of uteri. Intermediate results reveal an overall 96% (167/174) success in prolapse repair. Long term studies to assess efficacy along with patient satisfaction and sexual function are required before EPS can be considered the gold standard for pelvic floor prolapse repair and/or uterine preservation.