Vaginal paravaginal repair with an AlloDerm graft

• Published in: American journal of obstetrics and gynecology 2003-12, Vol.189 (6), p.1612-1618
• Main Authors: Clemons, Jeffrey L, Myers, Deborah L, Aguilar, Vivian C, Arya, Lily A
• Format: Article
• Language: English
• Subjects: Aged; anterior vaginal wall prolapse; Biocompatible Materials; Biological and medical sciences; Cohort Studies; Collagen - therapeutic use; Female; Follow-Up Studies; Graft; Gynecologic Surgical Procedures - methods; Humans; Medical sciences; Middle Aged; Patient Satisfaction; Probability; Prostheses and Implants; reconstructive pelvic surgery; Reconstructive Surgical Procedures - methods; Recovery of Function; Risk Assessment; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the genital tract and mammary gland; Treatment Outcome; Uterine Prolapse - diagnosis; Uterine Prolapse - surgery
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/S0002-9378(03)00929-3

This study was undertaken to describe outcomes of a technique of vaginal paravaginal repair that used AlloDerm graft (LifeCell, Branchburg, NJ) in women with recurrent stage II or with primary or recurrent stage III/IV anterior vaginal wall prolapse. This was an observational study. Thirty-three women underwent a vaginal paravaginal repair using AlloDerm graft. Anterior vaginal wall prolapse was staged using the pelvic organ prolapse quantification system preoperatively and every 6 months after surgery. Recurrence of prolapse, changes in functional status (urinary symptoms, prolapse symptoms, and sexual activity), and complications were recorded. Objective failure was defined as recurrent anterior vaginal wall prolapse, stage II or greater, and subjective failure as symptomatic recurrent anterior vaginal wall prolapse. Life-table analysis evaluated objective and subjective failure. Risk factors for recurrent anterior vaginal wall prolapse were evaluated. The mean age was 65.2 years and 93% of the women were white. Preoperatively, 6 women had recurrent stage II, 24 women had stage III, and 3 women had stage IV anterior vaginal wall prolapse. The median length of follow-up was 18 months. Postoperatively, 12 women had asymptomatic stage II anterior vaginal wall prolapse (not beyond the hymen) develop, and 1 woman had symptomatic stage II prolapse develop. Thus, there were 13 (41%) objective failures and 1 (3%) subjective failure. Life-table analysis demonstrated the cumulative probability of an objective failure was 0.24 at 1 year and 0.50 at 2, 3, and 4 years. The cumulative probability of a subjective failure was 0.00 at 1 and 2 years and 0.11 at 3 and 4 years. No risk factors for objective failure were identified. Voiding complaints resolved in 11 of 14 (79%) women ( P = .004), incontinence symptoms resolved in 17 of 19 (89%) women ( P