[Tolerance of synthetic tissues and vaginal surgery. Report of 287 cases].
OBJECTIVE
In this presentation, we attract attention to the disadvantage of using synthetic material in functional surgery of prolapse and urinary incontinence.


METHODS
Two hundred eighty seven vaginal operations using synthetic material (Gore Tex, Dacron and Lyodura) were followed. The operations were: Mouchel procedure (127 cases), small slings (118 cases), large slings (11 cases), Stamey procedure (8 cases) and patch for paravaginal repair (23 cases). These operations were performed from 01/01/89 to 31/12/95.


RESULTS
Mean follow-up at study end was 49 months. The intolerance phenomenon, leading to rejection, occurred between 1 and 72 months. The Mouchel procedure gave a rejection rate of 28.3% versus 9.3% for the slings (p < 0.001). Dacron was better tolerated (rejection rate at 19.3%) than Gore tex (rejection rate at 30.2%), p < 0.05.


CONCLUSIONS
The substratum of the intolerance process would have two explanations (infection and foreign body reaction) for the early and late rejections. We suggest that the synthetic tissue tolerance is proportional to the exposed surface and to the distance which separates it from the vaginal scar. The ideal synthetic mesh material for pelvic surgery has yet to be developed.
Debodinance
P
P
Service de Gynécologie-Obstétrique, CH Dunkerque, Saint-Pol-sur-Mer.
Cosson
M
M
Burlet
G
G
Engrand
J B
JB
Delporte
P
P
Boulogne
M
M
Querleu
D
D
Crépin
G
G
D003094:Collagen; D005260:Female; D006084:Graft Rejection; D006801:Humans; D008422:Materials Testing; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene; D014549:Urinary Incontinence / Q000601:surgery*; D014596:Uterine Prolapse / Q000601:surgery*
C032281:Lyodura; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene; D003094:Collagen