Use of synthetic mesh and donor grafts in gynecologic surgery

Traditional surgery for the correction of pelvic organ prolapse continues to result in suboptimal long-term cure rates. In an effort to improve clinical outcomes, various new surgical techniques have been proposed and use of synthetic and donor graft has been advocated. Although the technique of graft placement for the correction of anterior, posterior, and apical vaginal wall reconstruction is easy to perform, controversy exists regarding the optimal choice of material. Synthetic materials have the advantage of being readily available, cost-effective, and consistent in quality, but may present with significant complications, including infection and erosion. In contrast, autologous and heterologous donor grafts provide naturally occurring biomaterials that may undergo desired remodelling, but the in vivo tissue response is still not fully understood. The use of graft materials is still in an early period of evaluation and it is expected that its use will steadily rise with increasing experience and new product development. The following review analyzes our current experience with the use of graft materials in reconstructive pelvic surgery.