V1-08: Sacrocolpopexy with Autologous Fascia
VideoIntroductions and Objectives
Abdominal sacrocolpopexy (ASC) with mesh has been regarded as the most durable operation for advanced pelvic organ prolapse (POP). However, recent reports estimate that there is a 10.5% risk of mesh erosion at 7 years, with either symptomatic or anatomic failure in 34-48% of cases. There are few alternatives noted in the literature to manage severe mesh complications. We propose a novel technique using a patient’s own rectus fascia in lieu of mesh to perform ASC, in the setting of SCP mesh removal.
After IRB approval was obtained, a retrospective review was performed using medical records of patients referred to our tertiary care center for mesh complications following ASC from January 2012 to October 2013. All patients underwent complete ASC mesh removal transabdominally, with concomitant ASC with autologous fascia. A lower midline incision was used to remove the previous mesh, and a 10x2 cm segment of anterior rectus fascia was harvested longitudinally. The fascial segment was then configured into an “L”-configuration; the superior aspect was sutured to the sacral promontory, and the inferior portion was sutured to the vaginal cuff, both using #1 delayed absorbable sutures.
10 patients were included in the study. Mean age was 56.5 years. Mean BMI was 28.0 (22.8-38). Mean time from original SCP was 61.9 months (15-128 months). Prior SCP consisted of 7 open, 2 robotic, and 1 laparoscopic SCP. The original SCP was performed with polypropylene (n=4), Prolene (3), Mersilene (1), or Goretex (1) mesh, and all were placed with permanent sutures (Prolene, Gore-Tex, Ethibond). Presenting symptoms included dyspareunia (7), vaginal pain (5), vaginal bleeding (4), lower back pain (5), lower abdominal pain (5), hip pain (4), recurrent urinary infections (3), and defecatory dysfunction (4), as well as one rectovaginal fistula. On presentation, 3 had cystoceles, 2 had enteroceles, and 2 had rectoceles. Mesh could be palpated or seen on 5 patients. During the ASC with autologous fascia, mean EBL was 317 cc, and mean hospital length of stay was 7 days. All patients reported significant improvement of their original symptoms at follow-up (mean 180 days) without any recurrent POP.
This is the first report to address the simultaneous management of severe mesh complications from ASC, and POP following ASC mesh removal. Abdominal sacrocolpopexy using autologous fascia is a safe and feasible alternative to the traditional SCP using mesh, although greater follow-up time is necessary to assess its durability and outcomes.