Transvaginal Paravaginal Native Tissue Anterior Repair Technique: Initial Outcomes

To present the surgical technique and initial outcomes for a novel lattice-work technique, developed to increase the durability of the native tissue repair.

All patients undergoing transvaginal anterior prolapse repair with a single surgeon with at least 30 days of follow-up were prospectively enrolled starting in 2017. All patients received the same repair (Fig. 1). 2.0 polydioxanone (PDS) sutures are placed at the level of the obturator fascia/arcus tendineus distally and proximally on each side. The midline anterior colporrhaphy is performed with 4 2.0 PDS sutures which are then intertwined with the obturator sutures and tied to form a lattice of sutures to reinforce the cystocele repair and elevate the central defect repair laterally. Clinic notes, objective physical exam, and standardized subjective patient questionnaires (Pelvic Floor Disorders Inventory) were evaluated for patient outcomes. Recurrence was defined anatomically (Pelvic organ prolapse-Q Ba ≥-1) and subjectively (bothersome vaginal bulge).

There were 109 patients enrolled with a mean follow-up time was 12 months. Over the follow-up period, there were 12 anatomic recurrences (11%). This was not associated with concomitant apical or posterior repair. Mean time to recurrence was 13.9 months. There were no intraoperative complications. Transient urinary retention was the most notable complication (19%, managed conservatively). Rate of de novo stress urinary incontinence was low at 4%.

This novel lattice-work technique is simple to perform and has excellent short term anatomic outcomes. Transient postoperative retention was observed; however, all cases self-resolved. Further follow-up is ongoing to characterize the long-term durability of this repair.