Native tissue repair was traditionally used to treat prolapse. It involves the use of sutures and the patient’s own tissue to restore the vagina to a natural position by reattaching it to the various supportive structures. Due to high recurrence rates associated with this procedure the development of alternative techniques, such as biological grafting has become popular.
This procedure has been reported to be associated with a high anatomic failure rate. Due to the high recurrence rates a shift towards alternative therapy such a biological grafts has been adopted.
Surgery with vaginal mesh involves the application of a synthetic mesh around the pelvic organs to give them permanent support following prolapse.
There are different types of synthetic mesh available, each differing in several physical properties. The mesh is placed around your pelvic organs to give them permanent support. Patients are administered general anaesthetic for the procedure. This surgery is usually for women with a stage three or stage four prolapse or a prolapse that has returned after previous prolapse surgery.
Many physicians have become reluctant to use synthetic mesh products due to the risk of mesh erosion, exposure, pain, dyspareunia and litigation. Synthetic mesh is permanent which can increase the risks for complications developing over time. Type 1 mesh has been the preferred type of synthetic mesh, but in spite of excellent anatomical cure rate with mesh application a high incidence of healing abnormalities and deteriorations in bladder, bowel and sexual functions remain to be resolved. The high incidence of complications associated with synthetic mesh has led to the shift in using biological grafts.
Mesh extraction is the process of taking out a synthetic mesh hammock used to correct prolapse and incontinence.
In removing the mesh, surgeons need to excise the surrounding tissues gently. This typically involves cutting out mesh and surrounding tissue and then stitching the area and repairing the damaged tissue. Subsequent surgery may be required to correct the original prolapse and/ or any other serious complications from the mesh.
Frequently reported complications from surgical mesh include chronic pain, infection, bleeding, and pain during intercourse, urinary problems and exposure of the mesh through the vagina. Due to this, the mesh will often be required to be extracted by a surgeon with extensive training and skill. Multiple surgeries may be required to remove the mesh in those women with complications but even if successful this may not resolve the problems entirely for a small number of women.
Because surgical mesh is considered a permanent implant, surgery to remove the mesh can be difficult and may increase the individual’s risk of additional complications or symptoms. Over time, the tissue grows into and around the mesh so removing the mesh without damage to the surrounding tissue and organs is a delicate process.
The high incidence of complications associated with synthetic meshes has led to the increased shift in using biological grafts to treat vaginal prolapse. This procedure involves the application of autologous material, commonly connective tissue, around the pelvic organs to give them permanent support following prolapse.
Connective tissue is the material of choice due to its cost-effectiveness, availability and biocompatibility. Grafts are harvested either from the rectus fascia or from outer thigh fascia lata. Patients will be given general anaesthetic for the procedure. This surgery is usually for women with a stage three or stage four prolapse or a prolapse that has returned after other prolapse surgery.
Most biological grafts breakdown and remain in the body no longer than 6 months, which from the standpoint of complications gives biological materials an advantage. Unlike synthetic meshes biological grafts obtained from the individual greatly reduces the incidences of complications as seen with synthetic materials. In addition, it minimises the risk of donor viral transmission. Biological grafts have been reported to possess upwards of 80% success rates, without the complications of synthetic mesh.
Depending on the material used there is the issue of durability and strength when using biological grafts. Most biological grafts breakdown and remain in the body for no longer than 6 months, which may mean that the procedure may be needed to be repeated.