Svetlana Kamoeva
Clinik K+31 Zapad, Russian FederationPresentation Title:
Long-term results after application of titanium mesh in reconstructive surgery of anterior and apical prolapse
Abstract
Background: Today the main approach to the treatment of POP is based on the application of Mesh. It can significantly reduce the number of recurrences and provide high quality of life. However, there are some complications, such as - vaginal synechiae, erosions, implant wrinkling, implant protrusion, dyspareunia, infection. Most of the problems resulted from chronic inflammation in the implantation area, which is associated with the endoprosthesis material. Initially prosthesis plays the role of a hammock and provide adequate regeneration of the patient’s own connective tissue. Nowadays, there is a large number of different Mesh types and methods of it’s implantation, but none of these implants are perfect. That’s why the world is searching for new materials to correct the genital prolapse.
Objective: To analyze the safety and effectiveness of implants from “titanium silk” in the treatment of POP. To evaluate long-term results after application of titanium mesh.
Material & Methods: A study in the Center of the pelvic surgery of Central Clinical Hospital of the Russian Academy of Sciences included 103 patients with a verified diagnosis of anterior and apical prolapse. All patients were operated on between July 2017 and September 2018. Mean age of the patients was 57.3 ± 7.9 years. In order to correct defects of fascial- ligamentous apparatus, organ-preserving volume of surgical intervention was performed. It’s included the implant application by carrying out a bilateral sacrospinal and anterior transobturator hysterocolpopexy by using “titanium silk” (density 24 g/m2) - Mesh 11,0 х 6,0 сm, made of titanium filament GRADE1 0,06 мм with pore size 2x2mm. The mesh was inserted and secured with suture material (Prolene 2/0). It is worth noting the special advantages of the implant: due to its tensile properties, the material can be easily cut with scissors without unraveling the structure, modeled and returned to its original state without changing its characteristics. Due to this, foreign material uses several times less in comparison with standard techniques, which use polypropylene implants during surgical treatment.
Results. Mean operative time were 34,4±5,3 min. Intraoperative bladder injury 2 (1.9%). To analyze anatomical effectiveness, vaginal examination and ultrasound diagnostic were performed in 6, 12 months after surgery. As a result, relapse in 6 cases (5.8%). Dyspareunia 1 (1.0%). The vaginal sonography shows correct position of mesh and elastic vagina without scarring and deformation of surrounding structures. It is impossible to palpate implant except obturator and SSL points of insertion. Vaginal wall was mobile and elastic in all cases. Important to note: during the follow-up period after surgery, no cases of erosion, vaginal shortening, etc. have been identified. We noted cystocele relapse in 3 (5,8%) cases after 5 year follow-up.
Conclusion: Ultra lightweight titanium mesh augmented POP repair showed high effectiveness and minimal complications rate comparable to conventional surgery. Our data suggest that titanium meshes is excellent for anterior and apical compartments, preserves vaginal elasticity and provide good remodeling of tissues, anatomic and functional outcome at short-term and long-term follow-up. Today, the application of titanium mesh has been improved, but the aim of our study was to perform high effectiveness of this operation in long-term follow.
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