The Comparison of Outcomes of Transvaginal Mesh Surgery with and without Midline Fascial Plication for the Treatment of Anterior Vaginal Prolapse: A Randomized Controlled Trial

Ching-Hsiang Chiang,Dah-Ching Ding,Chun-Shuo Hsu

doi:10.3390/jcm10091888

Ching-Hsiang Chiang, Dah-Ching Ding + Show 1 more

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https://doi.org/10.3390/jcm10091888

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Abstract

The aim of this study was to compare the clinical outcomes of transvaginal mesh (TVM) surgery with and without midline fascial plication for anterior prolapse repair. This is a prospective randomized trial in a teaching hospital. This study compared patients with anterior vaginal wall prolapse (POP-Q Ba > −1) who were randomly assigned to either transvaginal mesh (TVM, Avaulta SoloTM, CR Bard. Inc., Covington, GA, USA polypropylene mesh delivery system) (group A, n = 32) or TVM with concomitant midline fascial plication (group B, n = 32). The outcomes of anatomy correction and life quality were evaluated using a pelvic organ prolapse quantification system and questionnaires. Sixty-four patients were included from January 2011 through April 2014 in this study. Group A had a mean age of 63.7 years and a body mass index (BMI) of 25.4 kg/m2. Group B had a mean age of 62.9 years and a BMI of 25.4. The mean follow-up duration was 18.6 months (range 12–50). At the 12-month follow-up, anatomic recurrence was higher in Group A (5/31, 16.1%) than in Group B (1/30, 3.3%) but without statistical significance (p = 0.19). Improvements in symptoms and quality of life were not significantly different between the two groups. Mesh extrusion was detected in three of 61 patients (4.9%): two from group A (6.7%) and one from Group B (3.2%). TVM with concomitant midline fascia repair for anterior vaginal prolapse had a comparable anterior support and mesh exposure rate compared with TVM alone. Trial Registration: IRB-B09904021

Highlights

IntroductionPelvic organ prolapse (POP) is an anatomical change wherein the female pelvic organs (vagina, bladder, uterus, and/or rectum) descend into or through the vagina
Pelvic organ prolapse (POP) is an anatomical change wherein the female pelvic organs descend into or through the vagina
Karp et al suggest that the addition of concomitant midline fascial plication in anterior vaginal prolapse repair with a non-crosslinked biologic graft vaginal prolapse enhances the anatomic outcome [17]

Summary

Introduction

Pelvic organ prolapse (POP) is an anatomical change wherein the female pelvic organs (vagina, bladder, uterus, and/or rectum) descend into or through the vagina It is a common problem, with 50% of women reporting symptoms of pelvic organ prolapse in the UK [1]. Anterior colporrhaphy with native tissue repair has been the standard procedure for managing anterior compartment prolapse and has an acceptable success rate of 80–100% in case series [14]. It only achieves a 40–60% success rate in randomized trials and has a high recurrence rate of 38% within one to three years of follow-up [14,15]. Karp et al suggest that the addition of concomitant midline fascial plication in anterior vaginal prolapse repair with a non-crosslinked biologic graft vaginal prolapse enhances the anatomic outcome [17]

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