Poster 60: Fascia Lata for the Prevention of Recurrent Posterior Vaginal Wall Prolapse: Subanalysis of a Randomized, Controlled Trial

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OBJECTIVE: The objective of this study was to evaluate the efficacy of solvent dehydrated cadaveric fascia lata in preventing recurrent posterior vaginal wall prolapse during reconstructive surgery. METHODS: This was a subanalysis of all women enrolled in a prospective, randomized, controlled trial evaluating the impact of a 2 × 4-cm patch of solvent dehydrated cadaveric fascia lata on recurrent prolapse. Women with anterior vaginal wall prolapse to the hymenal ring and beyond were randomized to standard repair with or without a fascial patch in the anterior and posterior compartments. The patch was sutured in place between the plicated endopelvic connective tissue and vaginal epithelium. Subjects were evaluated by the POP-Q system preoperatively and at 2, 6, 12, 52 weeks postoperatively. Patients were also asked to return for follow up beyond 1 year. “Failure” was defined as ICS stage II posterior wall prolapse. Groups were compared using chi-squared or Fisher exact tests. Multiple logistic regression analysis was used to control for potential confounding variables. RESULTS: Of 154 subjects randomized from July 1999 to November 2002, 148 underwent posterior colporrhaphy (75 patch; 73 no patch). One hundred thirty-three subjects (90%) returned for either a 52-week or long-term evaluation. Baseline characteristics, including age, parity, previous reconstructive surgery, concomitant surgeries, and preoperative prolapse stage, were not significantly different between the 2 study groups. Thirteen of 75 subjects (17%) and 12 of 73 controls (16%) experienced recurrent stage II or greater posterior wall prolapse (P=0.772). Rates of postoperative dyspareunia (13% vs 11%), constipation (32% vs 35%), and fecal incontinence (8% vs 10%) were not significantly different between the 2 study groups. CONCLUSION: The use of solvent dehydrated fascia lata as a barrier during posterior colporrhaphy does not appear to decrease the rate of recurrent rectocele. Although grafts in the posterior compartment are being used with increasing frequency, comparative trials demonstrating improved anatomic or symptomatic outcomes are still needed.