title: Surgical repair of posterior compartment prolapse: preliminary results of a novel transvaginal procedure using a four-armed polypropylene mesh with infracoccygeal and pararectal suspension.
abstract: BACKGROUND
  Anatomical defects of the posterior vaginal compartment are a common reason for pelvic floor reconstructive surgery. The implantation of a four-armed monofilamentous polypropylene mesh with infracoccygeal and pararectal suspension is a recently introduced innovative technique, which is believed to reduce the risk of mesh retraction and prolapse recurrences, and additionally, allows a tension-free adjustment of the mesh.
  
  
  METHODS
  In this preliminary case series, we aimed to evaluate feasibility, intraoperative complications and short-term follow-up results of this novel surgical procedure in a multicentre approach. Seventy-three patients undergoing surgery for posterior vaginal compartment prolapse were enrolled. The mean follow-up time was 3.8 months (range: 2-6 months), and follow-up information was available in 60/73 (82.2%) women.
  
  
  RESULTS
  Intraoperative complications were observed in 4.2% of cases, 2 patients with blood loss >500 ml, and one bladder injury occurring during concomitant anterior compartment surgery. Importantly, there were no intraoperative complications directly related to the implantation technique (e.g. rectum perforations), and no prolapse recurrences at follow-up examinations 3-6 months postoperatively. Our short-term mesh erosion rate was 3.1%.
  
  
  CONCLUSIONS
  We conclude that this innovative procedure is a feasible and safe technique for the treatment of posterior vaginal compartment prolapse. Further prospective and multicentre trials are warranted.
authors.affiliation: Department of Obstetrics and Gynecology, Freiburg University Medical Center, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Grabriel
authors.forename: Juliane
authors.initials: J
authors.lastname: Farthmann
authors.forename: Bernhard
authors.initials: B
authors.lastname: Brintrup
authors.forename: Christian
authors.initials: C
authors.lastname: Fünfgeld
authors.forename: Peter
authors.initials: P
authors.lastname: Jezek
authors.forename: Alfons
authors.initials: A
authors.lastname: Kraus
authors.forename: Florian
authors.initials: F
authors.lastname: Lenz
authors.forename: Eberhard
authors.initials: E
authors.lastname: Kumbier
authors.forename: Achim
authors.initials: A
authors.lastname: Niesel
authors.forename: Elmar
authors.initials: E
authors.lastname: Stickeler
authors.forename: Dirk
authors.initials: D
authors.lastname: Watermann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D013526:Surgical Mesh; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000293:injuries; D014596:Uterine Prolapse / Q000601:surgery*