THE USE OF KNITTED POLYESTER FABRIC FOR COLPOSACROPEXY AND POSTERIOR REPAIR

Abbott, Philip D., M.D.

   Objective: To review the use of knitted polyester (polyethylene terephthalate) fabric in 70 patients repaired from 1996 to 1998.

   Methods: The author reviewed, retrospectively, the surgical outcome and long term course of the 70 patients.

   Results: There were no surgical complications observed. The outcome continues to be satisfactory through 2002.

   Conclusion: When a substitute for autologous tissue is indicated, knitted polyester fabric is an option.  Vaginal vault prolapse occurs when the muscular and fascial support mechanisms of the pelvic floor fail. Restoration of endopelvic fascial support is the surgical objective. The purpose of the paper is to focus on the use of knitted polyethylene terephthalate fabric to re-enforce the endopelvic fascia. Figure one outlines the characteristics of the fabric.
   Polyethylene terephthalate fiber is manufactured by CR Bard, Inc. It was introduced in 1954 by Michael DeBakey, M.D., as a cardiovascular graft and is still in use. Its use in pelvic reconstruction is off label.
   The material is non-coated and immunologically non-reactive. It meets criteria of ideal fabric in most aspects including microporosity for anchorage, temporal durability, strength and shape retention, freedom from infection, and ease of manipulation.
   All the cases were performed by the author. Pre-operative evaluation included examination and scoring for pelvic organ prolapse according to the standards proposed by Bump, Brubaker DeLancy, and Shull.5 The operative procedure was the same throughout. The retroperitoneal space was opened from the sacrum, across the cul de sac, posterior vagina and into the rectovaginal space. A strip of fabric was cut to the width of the vagina 15cm long. Permanent sutures were used throughout to anchor the fabric 5cm distal to the apex of the posterior vaginal wall. The apex of the vagina was positioned over the coccyx and the fabric sewn to the periosteum of the sacrum without tension. The remaining fabric was sutured to the anterior wall of the vagina after the bladder had been reflected. The peritoneum was closed leaving the fabric and vaginal apex in the retroperitoneal space. In 58 patients, a traditional posterior repair and paravaginal suspension was performed. In the last! 12 patients a strip of fabric 4cm wide was connected to the fabric already sutured to the posterior vaginal wall and to the pararectal endopelvic tissue and finally to the perineal body, completing the connection between the sacrum and the perineum.
   Outcomes of the two groups are summarized in Figures 2 and 3.

   Discussion: Knitted polyethylene terephthalate fabric, though approved for cardiovascular procedures, is a very acceptable alternative for the procedures described in this report. The success rate is high and the potential for complications is low. The long term follow-up has remained favorable. Autologous tissue for reconstruction remains the most acceptable if it can be identified and used. If an alternative is deemed necessary the knitted polyethylene terephthalate fabric described should be considered.