The efficacy of Marlex mesh in the repair of severe, recurrent vaginal prolapse of the anterior midvaginal wall,☆☆,

Presented at the Twenty-second Annual Meeting of the Society of Gynecologic Surgeons, Albuquerque, New Mexico, March 4-6, 1996.
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Abstract

OBJECTIVE: The study assesses the efficacy and complications of Marlex mesh in repairing severe recurrent anterior vaginal wall prolapse. STUDY DESIGN: Twenty-four patients with two or more postsurgical recurrences of severe anterior vaginal wall prolapse were divided into control and treatment groups. Transvaginal repair was similar between groups except for reinforcement of the anterior vaginal wall with synthetic mesh. Two examiners graded preoperative and postoperative support over the following 2 years (K = 0.9). Fisher's exact test, log-linear analysis, and analysis of variance were used to compare categoric and continuous variables. RESULTS: Four patients in the control group and none in the treatment group had recurrent anterior vaginal wall prolapse (p < 0.05). Three patients had mesh-related complications. CONCLUSION: Repair with a synthetic mesh decreased the expected incidence of severe recurrent anterior vaginal prolapse but was associated with common complications related to synthetic mesh. Mesh reinforcement is an effective treatment for severe recurrent prolapse of the anterior midvaginal wall. (Am J Obstet Gynecol 1996;175:1472-5.)

Section snippets

MATERIAL AND METHODS

Prospectively from January 1989 to December 1992, 24 patients were divided into control (12 patients) or treatment (12 patient) groups. All patients had at least two previous reparative procedures on the anterior vaginal wall (control group mean 2.3, range 2 to 4; treatment group 2.4, range 2 to 4) and at surgery had third- or fourth-degree support defects of the anterior vaginal segment. All patients desired preservation of vaginal function.

The control group was further divided into two

RESULTS

There were no statistical differences between groups in patient age, parity, weight, medical complications before surgery, preoperative grades of prolapse, intraoperative blood loss, or operating time (Table I).

The number and type of concomitant reparative procedures were identical in the two groups, with the exception of the mesh placement. There were no significant intraoperative complications in any either group. None of the patients had postoperative fever or other evidence of in-hospital

COMMENT

This procedure is not recommended as a primary procedure for the repair of the anterior vaginal segment. It is reserved for patients who have had two or more reparative failures. Although not without complications, none of the complications was severe enough to make the risks greater than the benefits from this operation.

The two basic principles in pelvic reconstructive surgery are simple and obvious: locate all defects and repair each defect. To accomplish this required performing reparative

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From the Division of Gynecology, Department of Obstetrics and Gynecology, University of Wisconsin Medical School.

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Reprint requests: Thomas M. Julian, MD, Department of Obstetrics and Gynecology, 600 Highland Ave., H4-648A, Madison, WI 53792.

0002-9378/96 $5.00 + 0 6/6/76164

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