Can levator avulsion be repaired surgically? A prospective surgical pilot study

Abstract

Direct surgical repair of a levator avulsion is feasible at the time of prolapse surgery. However, its effect on prolapse recurrence and hiatal dimensions is relatively disappointing, suggesting that there often is microscopic trauma and functional muscle impairment in addition to the avulsion.

Enlargement of the levator hiatus in female pelvic organ prolapse: Cause or effect?

“…28 A randomised controlled pilot trial has been started at four locations in NSW and Victoria. We have developed such a procedure, the 'Puborectalis sling', which will allow prospective testing of the hypothesis that reduction in hiatal overdistensibility reduces prolapse recurrence.…”

“…We have developed such a procedure, the 'Puborectalis sling', which will allow prospective testing of the hypothesis that reduction in hiatal overdistensibility reduces prolapse recurrence. 28 A randomised controlled pilot trial has been started at four locations in NSW and Victoria.…”

Third‐ or Fourth‐Degree Intrapartum Anal Sphincter Tears Are Associated With Levator Ani Avulsion in Primiparas

“…Levator ani trauma has been identified as an important risk factor for subsequent development of pelvic floor disorders 1 , 4 – 7 including pelvic organ prolapse. Various methods to repair the damaged levator ani muscle have failed, 8 , 9 making prevention of levator ani injury clinically important. Identification of risk factors has an important role in primary and secondary prevention.…”

Authors’ response re: Shek KL & Dietz H. Letter to the Editor Re: ‘Do ultrasound findings of levator ani “Avulsion” correlate with anatomical findings: A multicenter cadaveric study’

“…In this paper we have found that “avulsions” are associated with a narrowing of the PVM attachment depth . This may be the anatomical finding which is visible on MRI 28 , in delivery suite 29 , in the operating theatre and on clinical examination . We have proposed some explanations for this altered imaging finding such as the “avulsion” representing the early decent of the anterior compartment or that there is a change in the tissue composition.…”