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 d… Show more
“…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.…”
The clinical experience and review of the literature by the authors suggest that a porcine-derived acellular mesh is non-cytotoxic, pyrogenic or allergenic, and the application of a biomesh in the management of rectocele is effective and safe, and the risk of mesh erosion is very low.
“…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.…”
The clinical experience and review of the literature by the authors suggest that a porcine-derived acellular mesh is non-cytotoxic, pyrogenic or allergenic, and the application of a biomesh in the management of rectocele is effective and safe, and the risk of mesh erosion is very low.
“…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.…”
Section: Graft Use In the Posterior Compartmentmentioning
Graft use in vaginal prolapse surgery has become more common secondary to high failure rates seen with traditional repairs. Mesh has been shown to be successful when suspending the upper portion of the vagina with sacralcolpopexy and its use vaginally is in an attempt to reproduce those results seen from the more invasive abdominal approach. A recent Cochrane review has supported its use in the anterior compartment vaginally as lower failure rates have been shown. Vaginal mesh “kits” have been developed in an attempt to make these surgeries less invasive, more standardized, and easier to perform. One of the problems that does seem to be emerging is the thought that, just because these procedures are now being produced in “kits”, they can be completed by any surgeon. This may not hold true, as these are still advanced techniques that require advanced pelvic surgery skills and, therefore, it is up to surgeons to also understand this and the limitations of these procedures. The current paper reviews the history of the development of mesh kits, the techniques utilized, and the data that have been published to date on results and complications, and recommendations on how to avoid these complications. Although initial studies are encouraging, more will need to be completed prior to the recommendations of general use of these kits in all prolapse patients. We need to have further investigation on proper patient selection, we must continue research on graft composition, and we must continue to develop techniques to minimize complications of needle passage or mesh placement. Even after we gain this knowledge, it will still require advanced surgical skills to complete these types of surgeries, and to help minimize complications and maximize results.
“…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].…”
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