Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan;35(1):51-58.
doi: 10.1007/s00192-023-05584-4. Epub 2023 Jul 21.

Does variation of surgical technique affect native tissue anterior pelvic organ prolapse repair outcomes?

Emily Fairclough  1   2 , Julia Segar  3 , Suzanne Breeman  4 , Anthony Smith  1   2 , Jenny Myers  2 , Fiona Reid  5   6
Affiliations

Does variation of surgical technique affect native tissue anterior pelvic organ prolapse repair outcomes?

Emily Fairclough et al. Int Urogynecol J. 2024 Jan.

Abstract

Introduction and hypothesis: The Variation in Surgical Technique study (VaST), demonstrated the large variation in surgical techniques used in native tissue (NT) anterior pelvic organ prolapse (POP) repairs. However, there are few comparative studies of different surgical techniques. This study was aimed at exploring whether surgical technique influenced the outcomes of NT anterior POP repairs.

Methods: The surgical techniques of 22 consultant surgeons performing NT anterior POP repairs were filmed and categorised. These surgeons performed 809 anterior repairs within the PROlapse Surgery: Pragmatic Evaluation and randomised Controlled Trial (PROSPECT). Logistical regression models were used to determine the influence of the different surgical techniques on subjective and objective outcomes, using data collected during PROSPECT.

Results: In adjusted multivariate linear regression models, fascial-flap repair was associated with an improved subjective outcome (POP-SS) compared with midline plication (β = -2.50 [-4.42 to -0.57]; p = 0.01). At 12 months, separate fascial defect repair was associated with a poorer objective outcome than midline plication (OR 6.06 [1.82-3.52], p = 0.006). At 24 months, deep dissection was associated with a poorer POP-SS than superficial dissection (0.32-2.60, p = 0.0). Continuous-locking closure of the skin was also associated with improved POP-SS compared with continuous non-locking closure (12 months: β = -1.94 [-3.42 to -0.45], p = 0.01).

Conclusion: Surgical technique may influence the outcome of native tissue anterior POP repairs. Our results should not change practice but inform future research; to develop methods of explicitly recording surgical techniques and allow confirmation of the effect of these aspects of technique on outcome.

Keywords: Native tissue; Outcome; Pelvic organ prolapse; Technique.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Photographic illustrations of the methods of fascial dissection. a Superficial dissection, b deep dissection, c fascial-flap dissection
See this image and copyright information in PMC

References

    1. White GR. Cystocele–a radical cure by suturing lateral sulci of the vagina to the white line of pelvic fascia. 1909. Int Urogynecol J Pelvic Floor Dysfunct. 1997;8:288–292. doi: 10.1001/jama.1909.92550210001001b. - DOI - PubMed
    1. Colombo M, Vitobello D, Proietti F, Milani R. Randomised comparison of Burch colposuspension versus anterior colporrhaphy in women with stress urinary incontinence and anterior vaginal wall prolapse. BJOG. 2000;107:544–551. doi: 10.1111/j.1471-0528.2000.tb13276.x. - DOI - PubMed
    1. Altman D, Väyrynen T, Engh ME, et al. Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. Int Braz J Urol. 2011;37:675. doi: 10.1590/S1677-55382011000500028. - DOI - PubMed
    1. Glazener CM, Breeman S, Elders A, et al. Mesh, graft, or standard repair for women having primary transvaginal anterior or posterior compartment prolapse surgery: two parallel-group, multicentre, randomised, controlled trials (PROSPECT) Lancet. 2017;389:381–392. doi: 10.1016/S0140-6736(16)31596-3. - DOI - PubMed
    1. Cumberlege J. First do no harm. The Report of the Independent Medicines and Medical Devices Safety Review. London; 2020. p. 1–277. https://www.immdsreview.org.uk/downloads/IMMDSReview_Web.pdf - PubMed