Reinforcement of suspensory ligaments under local anesthesia cures pelvic organ prolapse: 12-month results

Abstract

Introduction and hypothesisIn 2005, a new minimally invasive procedure, the tissue fixation system (TFS) was reported. Like TVT (tension-free vaginal tape), the TFS works by creating a foreign body collagenous tissue reaction that reinforces a weakened pelvic ligament. The objective was to assess the effectiveness and perioperative safety of TFS in a day surgery clinic for the treatment of pelvic organ prolapse (POP).MethodsThe TFS tape was applied in a tunnel adjacent to natural ligaments to repair the anterior cervical ring and cardinal ligament, paravaginal tissues and uterosacral ligaments under local anesthesia/sedation.We prospectively studied 60 patients, mean age 67, between October 2008 and February 2010 at Women’s Clinic LUNA. Levels of POP were grade 2 (n = 20; 7 %), grade 3 (n = 30; 55 %), and grade 4 (n = 4; 7 %) according to the ICS POPQ classification. Fifty-four patients (90 %) who underwent a total of 162 POP operations presented for review. Follow-up was performed at 12 months. We defined surgical failure according to the ICS POPQ classification. We used prolapse quality of life (P-QOL) questions for QOL measurement.ResultsNinety-eight percent of patients were discharged on the day of surgery. Of the162 TFS operations reviewed, 157 were successful and 5 failed. The 5 failed operations comprised 4 cystoceles and 1 rectocele. Two patients developed cervical protrusions at the introitus at 6 months with no prolapse of the uterine body. We found 5 cases of erosion in 162 tape insertions. The total number of patients who had no complications, no surgical failures, no erosions, no sensation of bulging, and no cervical protrusions was 47 (87 %).ConclusionsThe TFS uses the same surgical principle for repair as the TVT; this principle vastly minimizes the volume of mesh used, erosions, and other complications.

Repair of damaged ligaments with tissue fixation system minisling is sufficient to cure major prolapse in all three compartments: 5‐year data

“…Because of its minimal nature, we have found the TFS method to be very suitable for the age group in which it was applied, women with a mean age of ≥70 years, often with comorbid conditions. Our results are consistent with those recently reported by Sekiguchi et al , though our surgery was not performed under local anesthesia.…”

Heterogeneity in post-intervention prolapse and urinary outcome reporting: a one-year review of the International Urogynecology Journal

“…Of 45 articles, 37 and 38 articles reported on objective and subjective outcomes respectively. Four articles reported on Bde novo stress urinary incontinence (SUI)^or Brecurrent prolapse,^where it was unclear how these were measured [3][4][5][6]. Three papers reported on outcomes that were a composite of objective and subjective measurements (de novo SUI, presence of SUI, prolapse cure) [7][8][9].…”

The mechanics of urethral closure, incontinence, and midurethral sling repair Part 3 surgical applications (1990‐2016)

“…Excessive exudate could loosen the adherence of the tape to cause surfacing, the commonest type of erosion. In a series of papers using the tensioned retropubic‐type minisling system for MUS and POP, Sekiguchi et al report zero erosions . The explanation may lie in the strong anchoring system of the device which may prevent surfacing: each anchor can hold 2.3‐3 kg.…”

“…In a series of papers using the tensioned retropubic-type minisling system for MUS and POP, Sekiguchi et al report zero erosions. 10,11,17,18 The explanation may lie in the strong anchoring system of the device which may prevent surfacing: each anchor can hold 2.3-3 kg.…”