Sacrocolpopexy using xenogenic acellular collagen in patients at increased risk for graft‐related complications

Abstract

We studied the long-term anatomical and functional outcome following sacrocolpopexy for apical vaginal prolapse using xenogenic grafts in a population at increased risk for graft-related complications (GRCs). Twenty-two consecutive patients with symptomatic apical prolapse were scheduled for laparoscopic sacrocolpopexy (LSC) with porcine grafts because they were presumed to be at risk for GRC, because of pre-existing vaginal ulcerations (n = 4), concomitant vaginal prolapse repair (n = 15), total hysterectomy (n = 1), or intra-operative abdominal contamination due to accidental laceration of the vagina, bowel perforation (n = 1) or the presence of infection (n = 1). Either small intestinal submucosa (n = 8) or dermal collagen (n = 14) was used. Outcome measures were GRCs, anatomical cure (<or=Stage I at any compartment), subjective cure, impact on bowel, bladder, and sexual function measured by a standardized interview. At study closure 20 (91%) patients were available for functional evaluation and 16 (73%) for anatomical evaluation at a mean follow-up period of 27.4 months. The GRC rate was 25% (n = 4) prompting reintervention in half, and including two patients with spondylodiscitis. The anatomical cure rate was 31.5%. Failures at the vault, anterior, and posterior compartments occurred in, respectively, 31%, 18.8%, and 50% of patients. The subjective cure rate was 60% and three patients (15%) underwent redo-LSC. The strategy of using xenografts in patients at risk for GRC, did not prevent these to occur and was associated with a high anatomical and functional failure rate as well as reoperation rate.