Total Autologous Fascia Lata Anterior and Apical Pelvic Organ Prolapse Repair: A New Technique and Initial Experience.

Abstract

OBJECTIVE\nTo address renewed interest in non-mesh transvaginal Pelvic Organ Prolapse (POP) repair since the FDA reclassification of transvaginal mesh, our goal was to develop a transvaginal sacrospinous fixation for anterior and apical POP using only autologous fascia lata. We report our experience in thirty-three patients.\n\n\nMETHODS\nAutologous Anterior and Apical Pelvic Organ Prolapse (AAA-POP) repair utilizes a 4\u202f×\u202f14 cm piece of fascia lata harvested through a 3-4-inch upper thigh incision. The graft is reconfigured to provide apical fixation to the sacrospinous ligaments and distal fixation to the obturator fascia. Patients were followed by history, SEAPI scores, POP-Q scores, and Visual Analogue Pain Score. Treatment success was defined as absence of symptomatic anterior or apical POP.\n\n\nRESULTS\n33 patients (mean age 63, mean follow-up 12 months) underwent AAA-POP. Treatment was successful in 31 patients (94%), and 2 failures were due to uterine prolapse. Mean harvest site VAP score was 0.27. Five and 7 patients developed non-bothersome thigh bulges and wound paresthesias, respectively. All 4 harvest-site seromas resolved, with 2 requiring simple aspiration. Eleven patients developed urinary retention, 10 (91%) of them after concurrent pubovaginal sling. All resolved after sling loosening (6 patients) or sling lysis (4 patients).\n\n\nCONCLUSIONS\nAAA-POP is an efficacious treatment for patients desiring non-mesh POP repair. Postoperative harvest site issues are minor and typically resolve with expectant management. Patients should be counseled about the potential risk of failure with a uterine-sparing approach and the risk of urinary retention with concurrent pubovaginal sling.