OUTCOMES OF VAGINAL RECONSTRUCTIVE SURGERY WITH AND WITHOUT GRAFT MATERIAL.

B. Vakili, T. Huynh, H. Loesch, N. Franco, R.R. Chesson

Louisiana State University Health Sciences Center, New Orleans, LA  

OBJECTIVE:  To evaluate the outcomes of vaginal surgery for pelvic organ prolapse (POP), comparing cases implementing graft augmentation to those without graft augmentation.

MATERIALS AND METHODS:  This was a retrospective cohort study of 312 patients having undergone vaginal surgery for symptomatic POP from February 1998 to January 2004. All subjects had surgery by one of the two senior authors who both specialize in the treatment of female pelvic floor disorders. At the discretion of the primary surgeon, in select cases graft augmentation had been used to support the anterior vaginal wall, posterior vaginal wall, or both. These cases were grouped together and compared to cases without graft. Prolapse staging was defined using the Baden-Walker Halfway staging system. Data was abstracted from the office charts. Statistical analysis was performed using t-test to compare means, Chi-Square to compare frequencies, Fisher’s Exact Test for non-parametric comparison, and logistic regression to control for additional variables.

RESULTS:  In this cohort, 98/312 (31.4%) had graft augmentation. The median follow up was 9 months [3-67 months]. In cases in which graft was used, there was no improvement in recurrent prolapse {34/98 (34.7%) vs. 91/214 (42.5%); p=0.190}, recurrent stage 3 prolapse {2/98 (2.0%) vs. 6/214 (2.8%); p=1.0}, recurrent incontinence {25/98 (25.5%) vs. 59/214 (27.6%); p=0.703}, or additional surgery for prolapse {8/98 (8.2%) vs. 20/214 (9.3%); p=0.734}. Patients receiving graft augmentation were older (65.4 vs. 60.7 [t301 =2.724; p=0.003]) and more parous (3.3 vs. 2.9 [t295 =2.371; p=0.018]), while trending towards a higher incidence of prior pelvic reconstructive surgery {48/98 (49.0%) vs. 80/213 (37.6%): [÷21 =3.615; p=0.057]}. After controlling for these factors there was still no difference in surgical outcomes. Post-operative complications such as vaginal/graft infection {18/98 (18.4%) vs. 10/214 (4.7%): [÷21 =15.431; p < 0.001]) and granulation tissue {38/98 (38.8%) vs. 37/214 (17.3%): [÷21 =16.994; p < 0.001]} were more common after cases using graft in the repair, leading to more post-operative visits (p=0.037). There was no difference in outcomes when comparing biologic and synthetic materials in the graft-augmented cases. In separate sub-analysis of anterior vaginal wall graft and posterior vaginal wall graft there was no difference in recurrence outcomes.

CONCLUSION:  In the early post-operative period, there was no improvement in surgical outcomes when using graft to augment vaginal repair of either the anterior vaginal wall, posterior vaginal wall, or both. Graft use leads to a higher rate of post-operative complications.

Key Words:  Prolapse, vaginal surgery, graft, complications, outcome

Disclosure - Grant/Research: N. Franco, Lilly; R. Chesson, Lilly; Consultant: N. Franco, AMS Inc.