Possibilities of surgical treatment of apical pelvic organ prolapse without the use of mesh implants

Introduction Due to the general trend of abandoning foreign mesh implants in gynecological practice and the lack of consensus on their use in the treatment of POP, reconstructive surgeries that do not require the use of implants have recently become increasingly relevant. Mesh-less surgery is associated with a lower risk of complications and mesh-associated erosions due to the absence of a large area of tissue contact with a foreign material that can cause negative consequences. The aim of the study was to compare intraoperative and long-term outcomes of two approaches to the treatment of pelvic organ prolapse. Materials and methods. A prospective clinical study included 100 patients suffering from apical prolapse combined with cystocele and/or rectocele. The first group underwent laparoscopic promontofixation of the cervical stump using mesh-less technology (n=50), and the second group underwent classical laparoscopic sacro-vaginopexy using a polypropylene mesh implant (n=50). Results and discussion. When performing mesh-less cervicosacropexy, dyspareunia does not occur in the long-term follow-up period, which is probably due to minimal dissection of the retroperitoneal spaces, which contributes to a lower risk of damage to the vascular and nerve structures. After performing sacrovaginopexy using a mesh implant in women with stage II–IV pelvic organ prolapse (n=50), it was shown that the anatomical success rate after 1 month was 92 % (46/50) versus 90 % (45/50) in group 1 (meshless) (p=0.265). Subjective analysis of patients’ complaints after 6 months did not reveal any significant differences. The level of personal satisfaction of patients was 94 % and 90 %, respectively. Conclusion. Mesh-less pelvic floor surgery characterized by a lower risk of complications and meshassociated erosions due to the absence of a large area of foreign material that can cause a number of negative consequences. It is necessary to continue longer studies in this area.