Tissue Fixation System posterior sling for repair of uterine/vault prolapse – A preliminary report

Abstract

Aims: To assess the posterior Tissue Fixation System (TFS) sling for repair of uterine/vault prolapse. Patients and 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.