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Update on the utilization of grafts in pelvic reconstruction surgeries

Le, Tam Ha; Kon, Leannea; Bhatia, Narender Nb; Ostergard, Donald Rc,d

Current Opinion in Obstetrics and Gynecology: October 2007 - Volume 19 - Issue 5 - p 480–489
doi: 10.1097/GCO.0b013e3282efdecd
Urogynecology

Purpose of review Implanted grafts are increasingly used by pelvic reconstructive surgeons and gynecologists. In addition, the marketing of a variety of grafts has been aggressively expanded without scientific evidence to support their use. This review aims to provide an update of the current status and role of grafts in reconstructive pelvic surgery and to review the current knowledge of the biology of currently marketed synthetic and biologic grafts.

Recent findings Xenografts are preferable to human tissue-banked grafts due to more predictable integrity. How these biomaterials compare to synthetics in terms of surgical outcomes has not been well studied, however. Absorbable materials that mimic some behaviors of synthetic and biological materials have been developed. Furthermore, several new techniques have been advocated with limited studies.

Summary While the reduction of surgical failure rates in vaginal surgery is desirable, the addition of graft materials must demonstrate improvement in anatomical, functional, and quality of life outcomes over time. Furthermore, future complications due to improper placement or movement of a graft and the possible shrinkage of the graft are of concern. Therefore, significant research is necessary for the preclinical testing of materials, and expertise needs to be developed for the management of complications.

aDepartment of Obstetrics and Gynecology, Long Beach Memorial Women's Hospital, Long Beach, California, USA

bDepartment of Obstetrics and Gynecology, Harbor-UCLA Medical Center, David Greffen School of Medicine, University of California, Los Angeles, California, USA

cDepartment of Obstetrics and Gynecology, University of California, Irvine College of Medicine, Orange, California, USA

dUrogynecology Fellowship Training Program and Gynecological Education, Department of Obstetrics and Gynecology, Associate Medical Director for Gynecology, Long Beach Memorial Women's Hospital, Long Beach, California, USA

Correspondence to Tam H. Le, MD, Ostergard Female Urology and Gynecology Partnership Medical Group, 701 E. 28th Street, Suite 212, Long Beach, CA 90806, USA Tel: +1 562 426 5630; fax: +1 562 492 9893; e-mail: bsgini@hotmail.com or fem_uro_gyn@yahoo.com

© 2007 Lippincott Williams & Wilkins, Inc.