Anterior Colporrhaphy

Outcomes of the traditional anterior colporrhaphy are largely limited to retrospective reviews and case series. Reporting of outcomes has been extremely subjective and, before the advent of the POP-Q system, pre- and postoperative staging have been quite variable between surgeons. Nonetheless, the reported recurrence rates after anterior vaginal wall prolapse repair have been quite high (range, 0%-59%) (Tables 8-3.1-8-3.3). A recent randomized trial performed by the Cleveland Clinic compared traditional anterior colporrhaphy, an ultra lateral anterior colporrha-phy technique, and a traditional anterior colporrhaphy with polyglactin 910 mesh for treatment of symptomatic anterior vaginal prolapse. After a median follow-up of 23.3 months, the recurrence rate (defined as prolapse that extends 1 cm proximal to the hymen or greater) was 30% to 46% and there was no difference in efficacy among the three groups.3

Table 8-3.1. Outcome of anterior colporrhaphy alone for treatment of anterior vaginal prolapse

Authors (Year)

No.of Patients

Study Design

Mean Follow-up

Recurrence (%)

Macer4 (1978)

76

Retrospective cohort

5-20y

20

Walter et al.5 (1982)

86

Prospective cohort

1-2.5y

0

Stanton et al.6 (1982)

73

Prospective cohort

2y

15

Porges and Smilen7 (1994)

486

Retrospective cohort

2.6y

3

Smilen et al.8 (1998)

245

Retrospective cohort

6mo

9.4

Weber et al.3 (2001)

74*

Randomized controlled trial

23.3mo

54-70

*A total of 114 subjects were enrolled in this trial. Seventy-four subjects underwent either a traditional anterior colporrhaphy (n = 39) or an "ultralateral" anterior colporrhaphy

(n = 33) without graft augmentation.

Table 8-3.2. Anterior colporrhaphy and needle suspension for treatment of anterior vaginal prolapse

Authors (Year)

No. of Patients

Study Design

Mean Follow-up (y)

Recurrence (%)

Raz et al.9 (1989)

120

Retrospective cohort

0.5-5

2.5

Miyazaki and Miyazaki10 (1994)

27

Retrospective cohort

3.5-4

59

Bump et al.11 (1996)

32

Randomized controlled trial

0.5

50

Dmochowski et al.12 (1997)

47

Retrospective cohort

1.25-6.75

17-40

Migliari and Usai13 (1999)

15

Retrospective cohort

1.5-3.25

7

Insofar as patch augmentation of standard anterior col-porrhaphy is concerned, there exist very few peer-reviewed manuscripts on the subject. This is largely attributed to the fact that follow-up is short and often postoperative evaluations have not rigorously adhered to pre- and postoperative POP-Q measurements to ascertain differences in the repairs. Nonetheless, the few reports in the literature are encouraging and suggest that routine use of patch augmentation with a variety of materials may decrease the alarmingly high rate of recurrent anterior vaginal wall prolapse and do so with minimal morbidity (Table 8-3.4).

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