1D. De Vita, 2S. Spartano, 3C. Sciorio
1Department of Obstetrics and Gynaecology, Ospedale S. Maria della Speranza, Battipaglia, Italy
2Hematology Department Università Cattolica del Sacro Cuore, Rome, Italy
3 Department of Obstetrics and Gynaecology, Ospedale S. Maria delle Grazie, Pozzuoli, Naples
In this retrospective study we analyzed safety, less invasive, functional outcome and satisfaction rate of posterior vaginal prolapse treated with Mono Incision Mesh Technique with Hexapro mesh and i Stitch in 12 patients.Mono Incision Mesh Implants for POP reinforcement reduced mesh mass, shortened mesh arms, reduced “blind” surgical steps. The aims of this innovative procedura were: improve the skill of pelvic floor surgeons, patient satisfaction, predictors of morbidity, cost-benefit and cost-utility aspects, long-term durability, risk factors for erosion and how much mesh is needed for permanent support.
Retrospective, single-center study, 12 patients The mean follow up was 18 months (range 4-26). Baseline 7 patients (70%) with stage 2 hysterocele-rectocele, 5 patients (30%) with stage 3 hysterocele-rectocele. We included only patients that wished to maintain the uterus when hysterectomy was not directly indicated, according to current guidelines. According to the Ulmsten’s theory, we analized the safety and success of Mono Incision Mesh Technique with Hexapro mesh and i-Stitch for the treatment of posterior vaginal prolapse (1). Hexapro mesh sagomated in exagonal form (7X7X6) inserted and fixed to the sacro-spinous ligament (SSL), with A.M.I. Suture Instrument (Arthrex Med. Inst Gmbh, Germany) were used to restore De Lancey’s I Level identifing sacrospinous ligaments (SSL) immediately adjacent to the sacrum/coccyx (2,3). Hexapro mesh sagomated were placed to restore rectovaginal fascia. with AMI instrument and procedures address this with and attachment of suspension Level 2 by anchoring mesh at ileococcygeal fascia of the pelvis (ATFP).The mesh is tailored to the size of the prolapse and it deal with level III failure with mesh around the perineal body posteriorly. Hexapro mesh, supplied by AMI ®,(A.M.I. Agency for Medical Innovation GmbH, Feldkirch), is ultralight and iso-elastic mesh. Technical specification are: weight 21 g m2, thicknes 0.38 mm, diameter of thread 7,6 micronm, shape of mesh structure hexagonal, volume material fraction <10%, stitch width length wise 22 mm, cross wise 2.4 mm, interstitial pore size 100 und 150 micronm, material polipropilene monofilament, ball burst strenght 120 N.
Patients were discharged home after 48 hours. No recurrences of the prolapse have been observed. Mean duration 50 minutes, mean blood loss 100 cc (50-250). Perineal and lumbar sacral pain, urinary retention =0, 2/10 urinary incontinence de novo treated with TVT-O after intraoperative stress test, any difficult defecation. No vaginal erosion. We did not experience any infections, urinary retention, pelvic haematomas, deep vein. Anatomical results were excellent, Level 1 support was assured through the posterior compartment, without constipation and rectal pain. This original technique reduce mesh mass, reduce blind surgical steps and is very cheap.
Mono Incision Mesh Technique with Hexapro mesh and i Stitch is efficacy and less invasive procedure for the treatment of posterior vaginal prolapsed, it is a way to have integrated approach to the apex in a patient with posterior dominant prolapsed. This innovative technique reduce postoperative pain and avoid trocar passages, ensuring strong upper support and restoration of all three level (De Lancey). We conclude that this innovative mininvasive procedure for the conservaqtive treatment of posterior vaginal prolapse improve the skill of pelvic floor surgeons, patient satisfaction, predictors of morbidity, cost-benefit and cost-utility aspects, long-term durability, risk factors for erosion and suppose that a small mesh is needed for permanent support in prolapse of 2°-3° stage.