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International Urogynecology Journal

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Open Access 01-08-2020 | Original Article

Surgical technique used in the UK for native tissue anterior pelvic organ prolapse repair (VaST)

Authors: Emily Fairclough, Julia Segar, Jenny Myers, Anthony Smith, Fiona Reid

Published in: International Urogynecology Journal | Issue 8/2020

Abstract

Introduction

The PROSPECT study found that outcomes for native tissue and mesh prolapse repairs are similar but mesh repairs have a 10% risk of exposure. The current UK surgical mesh pause has led to renewed interest in native tissue surgery. Previous studies of native tissue anterior repair surgical techniques have been limited by the questionnaire study design. The objective of this study was to describe and categorise native tissue anterior repair surgical techniques.

Methods

This prospective qualitative study used a purposive sampling strategy to recruit surgeons. Data were collected through video-recorded observations of surgery, audio-recorded interviews with surgeons and field notes. The study took place in urogynaecology theatres in 21 UK centres. Thematic analysis was performed using computer-based software and themes of surgical technique were developed.

Results

Thirty consultant surgeons were recruited. In all steps of the anterior repair procedure, infiltration, dissection, method of fascial repair, type and method of suturing and suture placement, surgical technique varied between surgeons. The filming of surgery followed by immediate validation with the surgeons gave greater insight. Surgeons’ terminology to describe techniques varied and the investigators' opinions of the techniques performed were not always consistent with the surgeons' descriptions. The concept of fascia in histological terms was not uniform amongst surgeons.

Conclusion

VaST has demonstrated significant variation in native tissue anterior repair surgical techniques and inconsistency in the terminology used to describe them. These inconsistencies may prevent future meaningful research of prolapse surgery. The variation in technique could affect surgical outcomes and this should be explored further.

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Title: Surgical technique used in the UK for native tissue anterior pelvic organ prolapse repair (VaST)
Authors: Emily Fairclough
Julia Segar
Jenny Myers
Anthony Smith
Fiona Reid
Publication date: 01-08-2020
Publisher: Springer International Publishing
Published in: International Urogynecology Journal / Issue 8/2020
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-019-04103-8

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Surgical technique used in the UK for native tissue anterior pelvic organ prolapse repair (VaST)

Abstract

Introduction

Methods

Results

Conclusion

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Abstract

Introduction

Methods

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Conclusion

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