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Can levator avulsion be repaired surgically? A prospective surgical pilot study
1Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, NSW, 2750, Australia, hpdietz@bigpond.com.
International Urogynecology Journal
|November 16, 2012
Summary
Levator avulsion repair is feasible via a vaginal approach, but prolapse recurrence remains a concern. This surgical technique showed patient satisfaction but limited impact on prolapse recurrence.
Area of Science:
- Urogynecology
- Pelvic Floor Surgery
- Reconstructive Surgery
Background:
- Avulsion of the puborectalis muscle is frequent in women with pelvic organ prolapse.
- Levator muscle avulsion can contribute to prolapse severity and recurrence.
Purpose of the Study:
- To evaluate a simple vaginal technique for levator reconstruction in women with prolapse.
- To assess the feasibility and outcomes of direct surgical repair of levator avulsion.
Main Methods:
- A prospective pilot study involving 17 women undergoing levator repair during prolapse surgery.
- A vaginal approach using lateral colpotomy and mesh reinforcement was employed.
Main Results:
- 20 levator repairs were performed without intraoperative complications.
- 76% of women reported satisfaction, but 5 experienced prolapse recurrence.
- Mean hiatal area decreased significantly (36.84 cm² to 30.71 cm²), P=0.001.
Conclusions:
- Direct surgical repair of levator avulsion is technically feasible.
- The technique's impact on prolapse recurrence and hiatal dimensions was disappointing.
- Microscopic trauma and functional muscle impairment likely contribute to persistent issues post-avulsion.
