Posterior repair with perforated porcine dermal graft

Abstract

Objective: To compare postoperative vaginal incision separation and healing in patients undergoing posterior repair with perforated porcine dermal grafts with those that received grafts without perforations. Secondarily, the tensile properties of the perforated and non-perforated grafts were measured and compared. Materials and Methods: This was a non-randomized retrospective cohort analysis of women with stage II or greater rectoceles who underwent posterior repair with perforated and non-perforated porcine dermal grafts (Pelvicol TM CR Bard Covington, GA USA). The incidence of postoperative vaginal incision separation (dehiscence) was compared. A secondary analysis to assess graft tensile strength, suture pull out strength, and flexibility after perforation was performed using standard test method TM 0133 and ASTM bending and resistance protocols. Results: Seventeen percent of patients (21/127) who received grafts without perforations developed vaginal incision dehiscence compared to 7% (5/71) of patients who received perforated grafts (p = 0.078). Four patients with vaginal incision dehiscence with non-perforated grafts required surgical revision to facilitate healing. Neither tensile strength or suture pull out strength were significantly different between perforated and non-perforated grafts (p = 0.81, p = 0.29, respectively). There was no difference in the flexibility of the two grafts (p = 0.20). Conclusion: Perforated porcine dermal grafts retain their tensile properties and are associated with fewer vaginal incision dehiscences.

Advantages of implantation of acellular porcine-derived mesh in the treatment of human rectocele – Case report

“…In the study by Taylor et al, 71 patients underwent Pelvicol® implantation for rectocele repair and mesh erosion was found in 7% of cases. However, the authors did not report the results of their procedure [16]. In the open randomized study by Dahlgren et al [17], 35 patients had colporrhaphy performed with the use of Pelvicol® mesh reinforcement, while 26 patients underwent conventional colporrhaphy due to recurrent rectocele.…”

Vaginal Mesh Kits for Pelvic Organ Prolapse, Friend or Foe: A Comprehensive Review

“…However, again, both types of repairs (plication or site-specific) rely on tissue that has already failed or is weakened; therefore, the use of graft material to augment or support the repair has begun in the posterior compartment with initial studies that show improved cure rates over traditional repairs that utilize biologic grafts [36,37]. However, graft use in either compartment is still limited by a lack of knowledge of the correct material to use and in what surgical setting the grafts may be efficacious.…”

Long-term outcomes after native tissue vs. biological graft-augmented repair in the posterior compartment

“…As such, graft augmentation with either mesh or biological implants has been investigated in hopes to minimize pain and improve anatomic outcomes. Some studies describe improved anatomical success rates as high as 96% [13][14][15][16][17][18][19][20][21]. While anatomic success rates with mesh have been promising, the widespread use of mesh has been limited due to concerns of complications including mesh erosions (up to 30%), dyspareunia (up to 69%), infections, or fistula formation [18,19,22].…”