Tissue Fixation System posterior sling for repair of uterine/vault prolapse -- a preliminary report.
OBJECTIVE
To assess the posterior Tissue Fixation System (TFS) sling for repair of uterine/vault prolapse.


METHODS
The TFS comprises of two small polypropylene soft tissue anchors connected to an adjustable polypropylene tape. The posterior TFS sling works much like a McCall procedure. The anchors are inserted just lateral to the uterosacral ligaments. Tightening the sling elevates the prolapsed uterus/vaginal vault. The study group comprised 67 patients who were assessed with a 24-h urinary diary, structured questionnaire, transperineal ultrasound, urodynamics, cough stress test, and 24-h pad test, pre and postoperatively.


RESULTS
Sixty-seven patients, mean age 65 years (35-87), mean weight 71 kg (38-117 kg), mean 1.6 previous pelvic operations, underwent posterior sling (level 1) repair for uterine/vault prolapse (fourth degree: n = 2; third degree: n = 17; second degree: n = 20; symptomatic first degree: n = 28). Level 2 (n = 18) and level 3 repairs (n = 18) were also performed as required. One patient was lost to the study. At mean 9 months' review (3-15 months), the prolapse repair had been successful in all but one patient. There were however, 14 de novo herniations postoperatively (20%), cystocoele 12, enterocoele 1, rectocoele 1. Operating time for the sling only was 5-10 min, and mean hospital stay was 1.5 days. Minimal analgesia was required.


CONCLUSIONS
The preliminary results indicate that the TFS posterior sling appears to work well in patients with uterine/vault prolapse. Longer term follow up and studies by other surgeons are required to fully evaluate this procedure.
Petros
Peter E P
PE
Department of Gynaecology Royal Perth Hospital, Perth, Australia. kvinno@highway1.com.au
Richardson
Peter A
PA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D017060:Patient Satisfaction; D011126:Polypropylenes / Q000627:therapeutic use*; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013526:Surgical Mesh; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000175:diagnosis* / Q000601:surgery*
D011126:Polypropylenes