Rectus Fascia Versus Fascia Lata for Autologous Fascial Pubovaginal Sling: A Single-Center Comparison of Perioperative and Functional Outcomes

Abstract

Objective To compare perioperative and functional outcomes of autologous fascia lata versus rectus fascia pubovaginal sling in female patients with stress urinary incontinence (SUI). Methods The charts of all patients undergoing pubovaginal sling for SUI from 2012 to 2017 at a single center were retrospectively reviewed. Patients were divided into 2 groups: those with the sling harvested from the fascia lata (FL group) and those with the sling harvested from the rectus fascia (RF group). Results Between 2012 and 2017, 105 women underwent pubovaginal slings: 21 using FL and 84 using RF. Operative time did not differ significantly between the FL and RF groups (84 vs 81.9 minutes; P=0.68). Estimated blood loss was lower in the FL group (91.7 vs 141.6 mL; P=0.04). There were more wound complications in the RF group, although this was not statistically significant (0% vs 14.3%; P=0.12). Overall complications were comparable between FL and RF groups (52.4% vs 48.9%; P=0.81), but the proportion of Clavien grade 2 or greater were higher in the RF group (4.8% vs 20.2%; P=0.11). Overall, wound complications accounted for 29.3% of postoperative complications in the RF group (12/41). Functional outcomes were comparable between FL and RF groups, with similar rates of patients without SUI symptoms after 1 month (82.4% vs 76.4%; P=0.74), 1 year (55.6% vs 63.8%; P=0.76), and at the latest follow-up (66.7% vs 65.8%; P=0.87). Conclusions When compared with rectus fascia for pubovaginal sling, fascia lata may decrease perioperative morbidity, especially wound complications, without compromising functional outcomes.

Comparison of perioperative adverse events following suburethral sling placement using synthetic mesh, autologous rectus fascia, and autologous fascia lata in a national surgical registry

“…These results are consistent with a Cochrane meta‐analysis, which found that suburethral slings using synthetic mesh may be associated with fewer perioperative adverse events based on low‐quality evidence 13 . While other single‐institution studies have found similar rates of adverse events, they are generally limited by a low sample size and may not have been adequately powered to detect differences 14–16 . In addition to lower rates of adverse events, our study also found that suburethral sling surgeries involving synthetic mesh were associated with significantly lower operative time (37 min vs. 105 min) and total hospital LOS (0 days vs. 1 day), which may also contribute to an overall decrease in surgical morbidity.…”

“…Likewise, a separate study conducted at a single institution compared perioperative and functional outcomes for autologous fascia lata and rectus fascia slings, revealing similar adverse event rates for both fascial harvest sites. 15 Our study further reinforces this finding in a more generalizable, national population.…”

Harvest of large fascia lata autograft: Outcomes in 108 patients

“…The efficacy of fascia lata autograft has been well established for autologous pubovaginal slings. In a single‐center study comparing outcomes of rectus fascia versus fascia lata autologous pubovaginal slings, Peng et al 20 found comparable functional outcomes between fascia lata and rectus fascia autologous slings; however, there were more wound and Clavien Grade II complications in the rectus fascia group. Lee et al 21 also observed acceptable continence outcomes over 8 years of follow‐up in patients who underwent fascia lata pubovaginal sling.…”

Primer caso comunicado en el Perú de cabestrillo de fascia lata en incontinencia urinaria de esfuerzo

“…Desde hace algunos años han surgido observaciones referentes al CS (8)(9)(10) , haciendo replantear sobre su tasa de éxito para ser considerada como la técnica de oro. Son principales complicaciones asociadas la erosión de malla y las infecciones (7,12) , lo cual podría deberse a que el sistema inmune reconoce al material sintético como cuerpo extraño, así como a la condición de hipoestrogenismo de pacientes con prolapso genital que usualmente desarrollan atrofia de la mucosa vaginal.…”

“…Sin embargo, los cabestrillos autólogos generalmente son colocados si fallan los sintéticos, por contraindicación al material sintético o porque la paciente prefiere evitarlos. Ha existido una alerta emitida por el Royal College-Commonwealth of Nations y el comunicado posterior de la FDA de detener la venta de CS para prolapso de órganos pélvicos, al advertir los riesgos de su empleo (9,10) . Como el uso del CFL ha mostrado tener buenos resultados, podría ser considerado una técnica primaria para IUE (11,12) .…”