Strengths and Limitations
The strengths of our study include the prospective collection of primary
outcomes, the size of our population, and the duration of follow-up. We
included both subjective and objective outcome measures as either type
of outcome measure alone may not capture the patient’s true experience
and quality of life after pelvic reconstructive surgery. PFDI-20 is a
validated measure of patient’s pelvic floor symptoms, which we were able
to compare across time for each patient. We present the largest cohort
of patients who underwent sacrocolpopexy using autologous rectus fascia
in the literature and our results provide valuable information for
providers and patients seeking alternatives to mesh sacrocolpopexy. We
were able to recruit patients for follow-up assessment up to over 6
years from the time of surgery, which allowed us to analyze the outcomes
for patients who had at least 3 years of follow-up.
Our results are limited by the fact that some data are collected
retrospectively, the range of follow-up time, and single institution
data. Certain demographic and medical history data were collected
retrospectively and may be limited by the accuracy of medical records.
Patients chose their surgical treatment after extensive counseling and
there is likely to be selection bias. However, our study is targeted at
this group of patients, who did not desire mesh material in their
prolapse surgery, in order to provide long-term outcomes data for a
non-mesh alternative to sacrocolpopexy. Due to the wide range of years
during which this procedure was performed and in order to collect a
large cohort of patients, some patients did not have long-term follow-up
available. We were able to analyze the subgroup of patients who had
long-term follow-up, which demonstrated similar outcomes and supported
our main results. Because this study was conducted at a single
institution, our patient population may not be generalizable to other
regions or countries.
Although our results showed that sacrocolpopexy using autologous rectus
fascia resulted in significant prolapse improvements and low rates of
retreatment, our cohort was subject to selection bias as described. Our
findings support future research utilizing randomized controlled trials
to provide more robust evidence for sacrocolpopexy using autologous
rectus fascia for patients who desire a non-mesh alternative.