Total pelvic floor reconstruction

Abstract

The pelvic organs are suspended by ligaments. Pelvic muscle forces stretch the organs against these ligaments to give them shape, strength, and function, much like a trampoline or suspension bridge. Childbirth stretches the ligaments and fascia laterally to cause fascial damage and ligamentous laxity. One consequence of this damage is organ prolapse. Another is organ dysfunction, because the ligaments also function as insertion points for the muscle forces that open or close the bladder and rectum. The core aims of this chapter are to present the anatomical principles of surgical repair and the importance of tissue tension in the restoration of both structure and function. Existing surgical options for total pelvic floor reconstruction are analyzed. The tissue fixation system (TFS) is presented as the next step in pelvic floor reconstruction. The TFS is a new minimally invasive technique. It uses a different bioengineering support principle, akin to that of a cathedral ceiling, for pelvic organ prolapse. Specific suspensory ligaments are reinforced with tensioned tapes, without vaginal excision. The surgical restoration of the prolapse is anatomically precise, with good restoration of organ function. The TFS allows normal organ movement, and few of the problems associated with major mesh reconstructions, such as mesh shrinkage, dyspareunia, and erosion have been reported. © 2010 Springer-Verlag Milan.