Repair of damaged ligaments with tissue fixation system minisling is sufficient to cure major prolapse in all three...

The ageing population in Japan brings problems of pelvic organ prolapse (POP), bladder and bowel incontinence, and fragility as regards major pelvic surgery. Existing data from tissue fixation system (TFS) surgery show high cure rates for these conditions, but long-term data are lacking. We aimed to elucidate the usefulness of TFS by assessing 5-year postoperative outcomes.

A total of 68 patients, mean age 70 years, underwent total pelvic floor repair. Cystocele, apical prolapse, and rectocele were variously addressed by TFS repair of pubourethral, arcus tendineus fasciae pelvis, cardinal, uterosacral, and perineal body ligaments using a mean 3.2 tapes per patient (n = 216). Patients were followed up at 12 months then yearly. We included patients with third- or fourth-degree uterine/vaginal prolapse (POP Quantification classification). We excluded patients with serious comorbid conditions.

The mean operating time was 88 min and the mean blood loss was 78 mL. There was minimal postoperative pain and urinary retention, as evidenced by a mean hospital stay of 0.8 days and early return to normal activities. The 5-year cure rates for urinary stress incontinence, urgency, nocturia, and frequency were 82%, 91.7%, 58%, and 52%, respectively. The surgical cure rate for POP was 87.1% at 12 months, falling to 79.0 at 60 months. The cumulative 5-year erosion rate was 0% and 1.7% for all ligaments except the perineal body (25.7%), reducing to 2.6% by year 5 following anchor placement into deep transversus perinei. Two cases of ileus were attributed to incorrect technique.

Reinforcing up to four ligaments with the TFS was sufficient for cure of third- and fourth-degree POP. The technique is minimally invasive, suitable for elderly women, and effective at 5 years for both anatomical and symptom cure.