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Grafts Offer No Added Protection Against Recurrence in Pelvic Prolapse


 

RANCHO MIRAGE, CALIF. — Graft augmentation did not offer additional protection against recurrence in patients undergoing vaginal surgery for symptomatic pelvic organ prolapse and was linked to an increase in postoperative complications in a review of 312 cases.

Two specialists in the treatment of pelvic floor disorders performed the surgeries over a 5-year period and used their discretion in select cases to add graft augmentation to support the anterior vaginal wall, posterior vaginal wall, or both.

Over a median 9-month follow-up, there were no differences in recurrence of prolapse or incontinence, or in the need for additional surgery between the 32% of patients who received grafts and those women who did not, Babak Vakili, M.D., said during the annual meeting of the Society of Gynecologic Surgeons.

Patients receiving graft augmentation had higher rates of postoperative complications, including vaginal or graft infection (18% vs. 5%) and granulation tissue (39% vs. 17%).

As a result, patients with grafts needed more postoperative visits—an average of four visits versus three visits, said Dr. Vakili of Cooper University Hospital, Voorhees, N.J.

The mean length of follow-up was 12 months in the graft group and 15 months in the other patients.

Recurrence rates were similar in both groups. (See accompanying graphic.) Eight percent of the graft group and 9% of the nongraft group needed additional surgery for incontinence.

Women in the graft group were older than in the nongraft group (65 years vs. 61 years), were more likely to be menopausal (93% vs. 83%), and were more parous (3.3 vs. 2.9 children). After controlling for these factors, investigators still found no difference in surgical outcomes.

A subanalysis comparing the cases by the biologic and synthetic materials in the grafts also found no difference in outcomes. Another subanalysis comparing anterior vaginal wall grafts and posterior vaginal wall grafts also found no difference in the likelihood of recurrent prolapse or incontinence.

“In the early postoperative period, there was no improvement in surgical outcomes when using grafts to augment vaginal repair of either the anterior vaginal wall, posterior vaginal wall, or both,” he said.

KEVIN FOLEY, RESEARCH/DESIGN

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