SHORT-TERM SURGICAL OUTCOME OF ANTERIOR COMPARTMENT REPAIR WITH MESH REINFORCEMENT

L. Quiroz, C.A. Medina

Jackson Memorial Hospital, University of Miami, Miami, FL

OBJECTIVES: To assess the surgical outcome of mesh reinforcement at the time of anterior compartment repair and describe the surgical technique of this approach

MATERIALS AND METHODS: A Retrospective review of forty-four consecutive patients from the senior author’s surgical practice underwent mesh reinforcement of the anterior compartment at the time of anterior repair between January 2001 and December 2003.  In all cases the mesh was attached in a standard fashion commencing at the attachment of the white line along the posterior aspect of the pubic bone to a point just anterior to the ischial spine.  All patients underwent a detailed history with site specific examinations; pelvic organ prolapse stage (POPQ) was assessed using ICS staging.  Good anatomical result is defined as a POPQ score at points Aa and Ba of  < -2.   Descriptive statistics and a paired t-test were used for statistical analysis.

RESULTS: Most cases 28(63.6%) employed vicryl mesh, other materials used included 9(20.5 %) prolene mesh, and 7(15.9%) Gynecare mesh.  Twenty-two (50%) patients had anterior compartment surgery with or without a posterior compartment repair, and no hysterectomy or apical suspension.  Thirty-three (75%) had a prolapse of stage 2 or greater, with the median POPQ score at points Aa and Ba of +1.  The mean EBL was 293.3 ± 371.9 ml. Two (4%) patients sustained intraoperative complications, one excessive blood loss necessitating blood transfusion and one cystotomy at the time of hysterectomy which was repaired in situ. The mean hospital stay was 2.5 (range 1-6) days. There were two immediate postoperative complications, one patient with a fever of unknown origin and another had a blood transfusion for a dropping hematocrit.  The mean follow-up time was 11 months.  For a subset of patients all with >11 months of follow-up, the mean follow-up was 22.5 months. In either group the median postoperative POPQ score at points Aa and Ba were -3 respectively, and no point beyond -2.  The difference in POPQ score at points Aa and Ba were significantly improved (p < 0.001).  There were two cases (4.5%) of mesh erosion at 5 and 19 months respectively, both occurred with prolene mesh.

CONCLUSION: The use of mesh to reinforce the anterior compartment at the time of anterior repair affords good anatomical results.  Utilizing permanent prosthesis along the anterior compartment warrants caution.

Disclosure – Nothing to disclose.