ENHANCED PRESERVATION OF VAGINAL LENGTH AND VAULT SUPPORT: A BYPRODUCT OF ANTERIOR COMPARTMENT REPAIR USING A SYNTHETIC MESH GRAFT 

C.R. Hanes, II and M.S. Mulekar

Providence Hospital & Mobile Ob/Gyn, P.C., Mobile, AL

OBJECTIVE: Preservation of vaginal length and restoration of vault support will be observed as byproducts of anterior repair using synthetic graft material.

MATERIALS AND METHODS: In this surgical comparison, the study group comprised 12 patients who had anterior repair using a trapezoidal piece of synthetic mesh. If present, an enterocele was repaired by transvaginal culdoplasty without uterosacral suspension. If present, a rectocele was repaired. Mean postoperative duration of 3 months will be updated with six-month data. The control group comprised 11 patients who had transvaginal suspension of the vaginal vault to the uterosacral ligaments with traditional anterior and posterior colporrhaphy. Mean postoperative duration is 14 months. Both groups are comparable with respect to demographics, comorbid conditions, preoperative POP-Q levels of support, and stage of prolapse.

Total vaginal length, points “Ba” and “C” (POP-Q) are endpoints to compare these two procedures. Depending on the situation, equal or unequal variances t test was used to compare the means of the two groups. The F test was used to compare the variation in characteristics and responses by the patients in both groups. 

RESULTS: Preservation of vaginal length (postop TVL – preop TVL) [t (21)=-2.443, p<0.05] and apical compartment support (TVL-C) [t (13.47)=1.902, p<0.05] were significantly better in the study group. Although not significant, restoration of anterior support (preop Ba – postop Ba) was also better [mean restoration: 2.818 (control); 3.500 (study), p=0.4195]. The differences in mean operating time [t(21)=1.869, p<0.05] and mean length of hospital stay [t(13.57)=3.037, p<0.05] were significantly shorter in the study group.

Four patients in the study group had some mesh erosion. Three were treated by office excision. The fourth was not symptomatic and elected no excision. There were no other differences in morbidity between the two groups. One patient in the study group had a short-term failure that was thought to be due to suture pullout or failure. She was reoperated using the same procedure; however, an enterocele was identified at the second operation and repaired. Preoperative and postoperative UDI-6 quality of life data are being reviewed and will be included in the final manuscript.

CONCLUSION: It may not be necessary to perform any other specific vault suspension when synthetic mesh graft material is fixed anteriorly using the technique described and when an enterocele, if present, is adequately reduced. This offers the benefit of a simpler procedure with shorter operating time and hospital stay. It also enables a minimum amount of graft material to be used without major short-term synthetic graft related morbidity.

Key Words: Vaginal length, synthetic graft, and anterior repair

Disclosure – Preceptor: C.R. Hanes, Gynecare.