Abdominal Sacrocolpopexy Utilizing Gore-Tex in Genital Prolapse

Abstract

In Brief Objective: To examine the efficacy and safety of abdominal sacrocolpopexy (ASC) for the treatment of genital prolapse and review unresolved issues, specifically the erosion rate with Gore-Tex in a concomitant total hysterectomy, and how best to attach the mesh to the prolapsed vagina. The rate of vaginal erosion of the most commonly used synthetic meshes is also reviewed. Methods: A 15-year prospective observational study was done on all patients undergoing ASC. The lead author performed all surgeries. Data collected included pelvic floor grading, urodynamic studies when indicated, concomitant surgical procedures, length of stay, and complications. The mesh used was expanded polytetrafluoroethylene and was attached in nearly all cases (96%) to the anterior and posterior vaginal wall. Follow-up was done by annual questionnaire or office visits. Results: A total of 168 patients with at least grade 2 prolapse underwent ASC. Eighty percent had long-term follow-up (mean, 43 months; range, 7–154) and the rest were followed less than 6 months (range, 1–6). Five intraoperative complications occurred (3%), yet no blood transfusions were needed. Postoperative complications developed in 29 patients (17%) with ileus or small-bowel obstruction in 18 (11%). Average hospital stay for uncomplicated and complicated cases was 3 days and 7.7 days, respectively. Graft erosion occurred in 4 patients (2.4%), with 3 of these having concomitant total hysterectomies (adjusted odds ratio = 21.9, 95% confidence interval = 2.57–462.8). Recurrent prolapse occurred in 3 patients (1.8%). In 2 of these patients, the failures happened after removal of the eroded mesh. Conclusions: The rate of intestinal complications in the present study (11%) is higher than comparable reports using a variety of meshes (4%-8%). The erosion rate of 2.4% in the present study is similar to other series. An ASC will restore upper vaginal support if the graft is applied to all prolapsed sites. Concomitant total hysterectomy appears to be a strong independent risk factor for vaginal erosion among women undergoing ASC with Gore-Tex mesh. A large series of abdominal sacral colpopexies using Gore-Tex is presented. There is discussion regarding mesh application, concomitant hysterectomy and mesh erosion. Unresolved issues are reviewed.