Comparación entre la corrección con mallas sintéticas vía vaginal del prolapso genital versus técnicas vaginales tradicionales. Clínica Universitaria Bolivariana, Medellín, Colombia 2006-2007

Objective: evaluating the recurrence of anterior wall and pelvic apical prolapse by comparing techniques for correcting pelvic failure via integral management using synthetic mesh compared to traditional ones. Methods: two cohort groups were evaluated at the Clínica Universitaria Bolivariana in Medellín, Colombia; the first group was treated with surgical vaginal synthetic mesh and traditional techniques were used with the second one. Two evaluations were carried out at six-month intervals following the surgery. Follow-up involved classifying the degree of recurrence and early or late complications. The gynaecologist carrying out the follow-up did not know the patients and did not have any information about the cohorts. Informed consent had been previously signed by each patient. Results: the most commonly recurring prolapse happened in the anterior compartment but occurred less frequently when vaginal synthetic mesh was used. No prolapses recurred in the posterior compartment in this cohort and a less frequent apical failure rate was also detected in this group. The techniques used in integral management protected against surgical failure. Six month follow up relative risk was 0. 26 (0.10-0.69 95%CI; p = 0.00 1). One-year follow-up confirmed that this technique did protect against anterior compartment failure (RR = 0.32; 0.12-0.81 95%CI; p = 0.004). Discussion: the surgical techniques used in integral management did protect against surgical failure. The greatest challenge for a pelvic surgeon lies in controlling the anterior compartment because of the different kinds of pelvic failure. Para-vaginal and posterior defects are not usually fixed during abdominal or traditional surgery, although they do become the target during integral management. The synthetic mesh used on the exposed cohort was placed in anatomical sites, aimed at producing tissue neo-formation and thereby rescuing the functional continence mechanism. A systematic review of Cochrane data (2007) supported this paper's results, reinforcing integral anterior compartment management and confirming that synthetic material use leads to a lower rate of recurrence.