Porcine dermal hammock for repair of anterior and posterior vaginal wall prolapse: 5-year outcome
ABSTRACT To estimate the long-term efficacy of acellular cross-linked porcine dermal implants for the substitution of prolapsed anterior and posterior endopelvic fascia. In addition, surgical techniques to improve outcome were examined.
Prospective longitudinal study (Canadian Task Force classification II-2).
Private urogynecology clinic.
Patients were reviewed who had Pelvic Organ Prolapse Quantification stage 2 or greater anterior and/or posterior pelvic floor defects repaired with porcine dermis from March 2000 through August 2002 with at least 5 years of follow-up.
Repairs consisted of endopelvic fascia implants side wall to side wall from the ischial spine to the vaginal introitus. Different techniques of dissection, wound closure, and tissue pliability were measured.
A total of 91 consecutive patients had endopelvic porcine dermal implants for pelvic organ prolapse. In all, 72 patients with a total of 82 defects had an objective cure rate of 81.6% and 86.4% at 5 years for anterior and posterior repairs, respectively. Concomitant anterior and posterior repairs had a 6 times higher objective failure rate. The method of dissection and mucosal wound closure significantly affected wound healing. Solid porcine implants had decreased tissue pliability. A significant improvement in quality-of-life questionnaires and high patient satisfaction occurred, shown by a visual analog scale.
Complete replacement of the endopelvic fascia with porcine dermis had a better outcome than reported in many studies using classic plication or plication augmentation repairs. Porcine was well tolerated with high patient satisfaction and improved quality of life. Solid dermal implants resulted in thick scar plates, yet had a low occurrence of de novo dyspareunia and did not appear to adversely affect sexual activity.
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ABSTRACT: : To compare the surgical outcomes 12 months after laparoscopic sacrocolpopexy performed with porcine dermis and the current gold standard of polypropylene mesh. : Patients scheduled for laparoscopic sacrocolpopexy were eligible for this randomized controlled trial. Both our clinical research nurse and the patients were blinded as to which material was used. Our primary end point was objective anatomic cure defined as no pelvic organ prolapse quantification (POP-Q) points Stage 2 or greater at any postoperative interval. Our sample size calculation called for 57 patients in each group to achieve 90% power to detect a 23% difference in objective anatomic cure at 12 months (α=0.05). Our secondary end point was clinical cure. Any patient with a POP-Q point greater than zero, or Point C less than or equal to -5, or any complaints of prolapse symptoms whatsoever on Pelvic Floor Distress Inventory-20 or Pelvic Floor Impact Questionnaire, Short Form 7, or reoperation for prolapse were considered "clinical failures"; the rest were "clinical cures." Statistical comparisons were performed using the χ or independent samples t test as appropriate. : As expected, there were no preoperative differences between the porcine (n=57) and mesh (n=58) groups. The 12-month objective anatomic cure rates for the porcine and mesh groups were 80.7% and 86.2%, respectively (P=.24), and the "clinical cure" rates for the porcine and mesh groups were 84.2% and 89.7%, respectively (P=.96). Pelvic Floor Distress Inventory-20 and Pelvic Floor Impact Questionnaire, Short Form 7 score improvements were significant for both groups with no differences found between groups. There were no major operative complications. : There were similar outcomes in subjective or objective results 12 months after laparoscopic sacrocolpopexy performed with either porcine dermis or polypropylene mesh. : ClinicalTrials.gov, www.clinicaltrials.gov, NCT00564083. : I.Obstetrics and Gynecology 01/2013; 121(1):143-51. DOI:10.1097/AOG.0b013e31827558dc · 4.37 Impact Factor
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ABSTRACT: The use of biologic grafts in the surgical treatment of pelvic prolapse repair has been an intriguing prospect for several years. These tissues have been thought to potentially combine favorable attributes of both autologous and synthetic tissues. These tissues are harvested and undergo complex decellularization, dehydration, terminal sterilization, and possibly cross-linking. It is these steps that determine the graft’s eventual biocompatibility and potential for remodeling. A PubMed literature search has revealed a number of studies evaluating cadaveric allografts and bovine and porcine xenografts in repairs of the anterior, posterior, and apical compartments. While the study quality varies significantly, overall, there is little compelling evidence to unequivocally support the use of a biologic tissue in any compartment. Furthermore, an analysis of postoperative complications reveals a similarity in graft-related complication profiles between some biologic grafts and synthetic meshes.Current Bladder Dysfunction Reports 09/2012; 7(3). DOI:10.1007/s11884-012-0139-6
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ABSTRACT: AIM: Laparoscopic ventral mesh rectopexy (VMR) is a surgical treatment option for internal and external rectal prolapse with low perioperative morbidity and low recurrence rates. Synthetic mesh use in the pelvis may be associated with complications such as fistulation, erosion and dyspareunia. Biologic meshes may avoid these complications, but the long-term outcome is uncertain. Debate continues as to which type of mesh is optimal for laparoscopic VMR. METHOD: A literature search was performed of electronic databases including Medline, Embase and Scopus (2000-2012). Studies describing outcomes relating to the mesh were included for review. Only English language studies were included. RESULTS: Thirteen observational studies reported the outcome of 866 patients following laparoscopic VMR. Eleven studies reported the outcome using synthetic mesh with a median follow up ranging from 7-74 months. Two studies reported the outcome with biologic mesh with a median follow up of 12 months. Pooled analysis of the studies demonstrated that 767 patients had a repair with synthetic mesh and 99 with a biological implant. There was no difference in recurrence (3.7% v 4.0%, p = 0.78) or mesh complications (0.7% v 0%, p = 1.0%) between synthetic and biologic mesh repair. CONCLUSION: Biologic meshes appear to be as effective as synthetic meshes in the short term for laparoscopic VMR. Mesh complication rates are low in both groups. Long-term follow up is required to ascertain if these findings persist. © 2013 The Authors. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.Colorectal Disease 03/2013; 15(6). DOI:10.1111/codi.12219 · 2.02 Impact Factor