Reducing mesh exposure in Posterior Intra-Vaginal Slingplasty (PIVS) for vaginal apex suspension

Abstract

OBJECTIVES:

Urogynecologists are constantly looking for simple, safe and effective ways to cure vaginal apex supportive defects. A novel surgical technique, Posterior Intra-vaginal Slingplasty (PIVS), was described recently to concomitantly achieve a high therapeutic efficiency with a low complication rate. Mesh exposure was reported to complicate up to 16% of the operations. This study evaluates surgical steps aimed to mesh exposure reduction in PIVS-operated patients.

STUDY DESIGN:

A total of 140 patients with vaginal apex prolapse were subjected to the PIVS operation in a daycare set-up by one of two surgeons: In the first surgeon’s patients group (N=66) the surgical vaginal incisions were made as small as feasible, the para-rectal dissection was performed at the infra-fascial level, and the mucosal edges were not trimmed. These surgical procedures, assumed to have some anti-mesh exposure value, were not performed in the second group of patients (N=74), who were operated by a different surgeon. Preoperative demographics, operative details and postoperative follow-up data were prospectively collected for all patients.

RESULTS:

The demographics in both PIVS patient’s groups were similar. A statistically non-significant improvement regarding the mesh exposure rate was observed in the patient’s group where the three anti-mesh-exposure surgical steps had been applied.

CONCLUSIONS:

Reduction of vaginal mesh exposure rate following PIVS might be achieved by performing three simple antiexposure surgical steps. However, more and long-term data is required for being able to draw solid conclusions concerning the superiority of the discussed operative techniques.