Vaginal Wall Repair – Using Amniotic Membrane Graft

Abstract

IntroductionThe surgical repair of vaginal wall prolapse continues to remain one of the most difficult challenges in female pelvic floor reconstruction. The recurrence rate after standard colporrhaphy [1] ranges from 40-60 %. This high recurrence rate creates the necessity for developing new surgical techniques and better longterm solutions.The majority of the anterior vaginal wall prolapse results from paravaginal defects 70% (lateral detachments from the ATFP) -mostly unilateral, on the right side, and at the level of the ischial spines; rather than midline defect. This new understanding of site specific vaginal defects has lead to changes in surgical techniques, to include, abdominal, laparoscopic, and vaginal repairs. Abdominal paravaginal repair requires a more invasive approach and a longer postoperative recovery, while laparoscopic approaches are technically more difficult and challenging. Repair of vaginal wall prolapse by the vaginal route is usually simpler, and easier.Surgeons have been investigating the use of synthetic and biological grafts in vaginal wall prolapse repairs. The use of an absorbable polyglactin 910 mesh (Vicryl) has shown little benefit in its use to correct vaginal wall prolapse (42%) [2] and the use of a synthetic permanent polypropylene mesh for vaginal repair shows a mesh erosion rate of 18% [3], de novo urgency rate of 20%, and dysparunia 22% postoperatively. The mesh erosion rate or infection rate increased four-fold when the mesh was introduced vaginally as compared to the abdominal route in pelvic floor reconstruction cases [4].Many pelvic surgeons, are now using biological grafts for vaginal prolapse surgery, such as cadaveric fascia lata [5,6], Research Article AbstractBackground: Standard colporraphy has been the main surgical procedure for vaginal wall prolapse for many years, with disappointing cure rates. Many investigators are now searching for alternative surgical techniques and materials to achieve better long term, postoperative results. Amniotic membrane is a natural human membrane tissue; when used as a vaginal graft, it will attract collagen, fibrinogen, and integrate with the local fascia providing a tough sheath, necessary for support and augmentation of the weak local fascia, to support the bladder, rectum, and vagina. It has been proven to demonstrate low antigenicity (incomplete HLA-A, B, C, and DR antigens), and hence will not be rejected by the recipient.

Successful pregnancy outcome after septum resection and use of amnion graft in patient with high transverse vaginal septum

“…Amniotic membrane has low antigenicity (incomplete human leukocyte antigen A, B, C and DR antigens), and the risk of rejection is very low. When the membrane is used as a vaginal graft, it draws fibrinogen and collagen into the local fascia, thus strengthening the weak local fascia.3 4…”

Application of Gamma Irradiated Amniotic Membrane as a Scaffold in Surgical Repair of Vaginal Wall Prolapse.

“…Table (5) shows that: Fibrosis formation statistically was non-significantly less frequent in amniotic membrane group. Table 7: Comparison between the studied groups regarding six-month recurrence Table (7) shows that: Six-month recurrence statistically was non-significantly less frequent in amniotic membrane group.…”

“…The use of Amniotic Membrane as a possible biological graft material came to our attention because it is non-immunogenic, meaning it`s not going to be rejected, and because it is a protein, the body will integrate and absorb it after attracting fibrin and collagen, providing the proper support 4,5 .…”

Amniotic Membrane-Coated Polypropylene Mesh for the Repair of Incisional Hernia: An Experimental Study In a Rat Model of Abdominal Wall Defect

“…Multiple authors have described the use of fresh human AM for transplantation in vaginal prolapsed repairs without serious complications (16,21,22) In direction of these studies, the current researchers intended to use fresh allograft AM-Coated Polypropylene Mesh (AM-CPM) in rats.…”