The efficacy of Marlex mesh in the repair of severe, recurrent vaginal prolapse of the anterior midvaginal wall☆,☆☆,★
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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Cited by (304)
Update in Transvaginal Grafts: The Role of Lightweight Meshes, Biologics, and Hybrid Grafts in Pelvic Organ Prolapse Surgery
2021, Obstetrics and Gynecology Clinics of North AmericaCitation Excerpt :This high recurrence rate of vaginal prolapse and repeat surgery have encouraged the use of surgical scaffolds to support and provide longevity to the prolapse repair. Inspired from their successful use in hernia surgery, scaffolds initially in the form of nonabsorbable dense polypropylene mesh were developed and have been utilized since the 1990s.7 Subsequently, there has been advancement in mesh materials, sophistication of the insertion process using mesh kits, and research into alternative graft materials.
From anatomy to patient experience in pelvic floor surgery: Mindlines, evidence, responsibility, and transvaginal mesh
2020, Social Science and MedicineCitation Excerpt :Nicita hypothesized his use of synthetic mesh would resolve and prevent recurrence of all types of prolapse “by returning the viscera to their correct anatomical seat.” In a pivotal 1996 study in which an experimental group of twelve women with “severe, recurrent anterior wall” prolapse were treated with the transvaginal placement of a Marlex polypropylene mesh, Julian (1996) argued the failure of these patients’ previous surgeries was due to what he called “underlying connective tissue weakness.” Julian reported 100% success in the group treated with mesh, as indicated by the absence of descent of the anterior segment at two-years follow-up.
What transvaginal meshes (TVM) surgery tells us about conflicts of interest
2020, Journal of Gynecology Obstetrics and Human ReproductionProspective long-term results, complications and risk factors in pelvic organ prolapse treatment with vaginal mesh
2017, European Journal of Obstetrics and Gynecology and Reproductive Biology
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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.
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