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Author Spotlight: Advancing Pelvic Prolapse Treatment with a Non-Mesh Approach using Laparoscopic Pectopexy

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Surgery for posterior vaginal wall prolapse.

Mickey Karram¹, Christopher Maher

¹The Christ Hospital, Cincinnati, OH, USA.

International Urogynecology Journal

|October 22, 2013

Summary

Midline fascial plication without levatorplasty is recommended for posterior vaginal wall prolapse surgery. Current evidence does not support using mesh or grafts for this condition.

Area of Science:

Urogynecology
Pelvic Floor Surgery

Background:

Posterior vaginal wall prolapse affects many women.
Surgical interventions aim to restore pelvic anatomy and function.

Purpose of the Study:

To review the safety and efficacy of surgical procedures for posterior vaginal wall prolapse.
To provide evidence-based recommendations for surgical management.

Main Methods:

Systematic review of English-language scientific literature up to January 2012.
Literature search included PubMed, Medline, Cochrane library, and Cochrane database of systematic reviews.
Evidence classified by level (1-4) and recommendations graded (A-D) based on the Oxford grading system.

Main Results:

Midline fascial plication without levatorplasty shows superior objective outcomes compared to site-specific repair (Grade B).

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Transvaginal approach is superior to transanal approach for posterior wall prolapse repair (Grade A).

No evidence supports mesh or graft augmentation for posterior vaginal wall prolapse repair (Grade B).

Conclusions:

Midline fascial plication without levatorplasty is the preferred surgical procedure for posterior compartment prolapse.
Current evidence does not support the use of polypropylene mesh or biological grafts in posterior vaginal compartment prolapse surgery.