Prolapse repair moves toward tissue replacement: synthetic and xenogenic products.(Gynecology)

LAS VEGAS -- Leave the tired, old endopelvic fascia alone and use synthetic or xenogenic replacements if you want a pelvic organ prolapse repair to last, Dr. Jim W. Ross said at an international congress of the Society of Laparoendoscopic Surgeons.

In the past 7 years, site-specific repairs that use the tissue involved in the actual defect have become the most popular surgical treatment for pelvic organ prolapse. These repairs fail in about 24% of the cases at his clinic, said Dr. Ross, one of the early leaders in pelvic reconstructive surgery.

That "extremely high" failure rate echoes the recurrence rates seen 10-12 years ago in general surgery for inguinal or ventral wall hernias. Since then, surgeons have reduced failure rates for those procedures to 2%-4%. "They stopped using the poor in situ tissue and went to tissue replacement. I feel that's where gynecology is going to now," said Dr. Ross of Salinas, Calif.

Several synthetic and xenogenic products are available from competing manufacturers.

A study soon to be published by Dr. Ross and his associates found that 7% of monofilament meshes eroded during nearly 10 years of follow-up in 51 posthysterectomy patients who underwent pelvic organ prolapse repair. Similar erosion rates have appeared in the published studies so far, nearly all of which involved Prolene mesh.

With newer and better polyfilament polyester meshes available, there's no good reason to work with the more difficult Prolene mesh, he noted.

Some of the newer meshes come with a coating of hydrophilic type 1 collagen on one side that prevents adhesions to bowel and other tissues. Dr. Ross soon will start testing a composite polyfilament mesh coated with collagen on both sides, which may be even more protective, he said.