Surgery Slows, Reverses Pelvic Floor Dysfunction.

BALTIMORE -- Add suture rectopexy to abdominal sacral colpoperineopexy for even greater support of the posterior attachments to the investing fascia of the rectum, Dr. Howard S. Kaufman advised.

Combining these procedures, particularly in women with either full-thickness or internal rectal prolapse, and using an AlloDerm acellular cadaveric skin graft may hold promise for improved outcomes, Dr. Kaufman said at a urogynecology meeting sponsored by Johns Hopkins University.

The modified surgical technique and the AlloDerm graft were used in 11 women who underwent the combined surgery for symptomatic perineal descent at Johns Hopkins Hospital, Baltimore, between July 1998 and April 2000.

AlloDerm, which is composed of mostly collagen and elastin, was chosen in an effort to reduce the incidence of graft erosion. In an earlier study of 19 women who underwent abdominal sacral colpoperineopexy, grafts made from Mersilene mesh had an unacceptably high rate of erosion. Erosion into the posterior vaginal wall occurred in 40% of the women.

So far, the results of the combined approach look promising. "The encouraging early results suggest that reestablishment of central support using this approach may help reverse or slow the progression of pelvic floor dysfunction in women with perineal descent," said Dr. Kaufman of Johns Hopkins University. He cautioned that long-term follow-up is needed to determine the durability of AlloDerm and the anatomic conceptual basis of this repair procedure.

Of the 11 women, 7 had sigmoid resection and 4 did not. The mean age of the patients was 57, and 82% had undergone previous pelvic surgery. All women had additional multicompartmental pelvic floor defects by imaging and on physical exam; 5 women had stage II prolapse, 5 had stage III, and 1 had stage IV.

Nine of the 11 women were disease free at a mean of 12.5 months, but 2 had recurrence with apical support defects. Quality of life improvements ...