ABSTRACT

Background:

Existing POP surgery methods repair vagina and ignore ligaments. The 1993 Integral Theory created a new strategy for pelvic floor surgery, site specific ligament repair

Aim:

The objective of this study was to evaluate the anatomical and symptomatic success rates of a modified infracoccygeal sling procedure (P-IVS) for apical prolapse.

Methods:

267 patients with symptomatic POP in various grades, underwent P-IVS operation between October 2009 and January 2014 modified by suturing each side of the tape to the sacrospinous ligament. Where required a modified anterior transobturator mesh (ATOM) procedure was performed for cystocele. All had follow-up for at least 1 year.

Results:

Mean age was 54.9 (28-88) years, mean operation time 149.8 (95-225) minutes, mean hospital stay 2.9 (1-10) days and mean follow up time 28.7 (12-63) months. Preoperatively 86.5% of the patients had anterior, 99% had posterior and 100% had apical prolapse. When surgical success was defined as grade 0 or grade 1 according to Baden-Walker, success rates for anterior, posterior and apical compartments at 3rd month were 92.1%, 98.1% and 97.3%; and 82.4%, 96.2% and 95.4% after ≥1 year, respectively. There was a statistically high improvement (p<0001) in all symptoms, such as urinary stress and urge incontinence, nocturia, urgency, pad use, fecal incontinence, difficulty in defecation, pelvic pain and quality of life.

Conclusions:

Total pelvic reconstruction with bilateral SSLF of P-IVS tape in combination with ATOM and TOT, if necessary, has a high success and low complication rate. Experience and strict attention to surgical principles are important for good symptomatic and anatomical results.