Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Total pelvic mesh repair

A ten-year experience


INTRODUCTION: This report describes our technique and experience in restoring the pelvic floor of females with pelvic organ prolapse. METHODS: Total pelvic mesh repair uses a strip of Marlex Mesh® secured between the perineal body and the sacrum. Two additional strips, attached to the first, are tunneled laterally to the pubis and support the vagina and bladder laterally. Candidates for the procedure have failed previous standard repair or manifest combined organ prolapse on physical and cystodefecography exams. RESULTS: From January 1990 to December 1999, 236 females had total pelvic mesh repair, and 205 (87 percent) were available for follow-up. Median age was 64 (range, 32–89) years, median parity 2 (range, 1–9); 63 percent had birth-related complications. Bladder protrusion, vaginal protrusion, or both were the predominant chief complaint (54 percent), followed by anorectal protrusion (48 percent). Findings on physical examination showed degrees of prolapse of rectum (74 percent) and vagina (57 percent), perineal descent (63 percent), enterocele (47 percent), and rectocele (44 percent). Mean procedure time and length of hospital stay were 3.2 (standard deviation 0.75) hours and 6 (standard deviation 2.2) days, respectively. Reoperation rate because of complications of the total pelvic mesh repair procedure was 10 percent. Marlex® erosion into rectum or vagina occurred in 5 percent of patients and constituted 46 percent of the complications requiring reoperation. Additional surgical procedures at various intervals subsequent to total pelvic mesh repair have been performed in 36 percent of patients to further improve bladder function and have been performed in 28 percent of patients to improve anorectal function. There has been no recurrence of rectal or vaginal prolapse to date. Reports of overall satisfaction for correction of primary symptoms for patients grouped into early (0.5–3 years), middle (>3–6 years) and late (>6 years) were 68 percent, 73 percent, and 74 percent respectively. CONCLUSION: Total pelvic mesh repair is a safe and effective operation for females with pelvic organ prolapse.

This is a preview of subscription content, log in to check access.


  1. 1.

    Owings MF, Lawrence L. Detailed diagnoses and procedures, National Hospital Discharge Survey. National Center for Health Statistics 1997:Series 13, No. 145;1–164.

  2. 2.

    Olson A, Smith V, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997;89:501–6.

  3. 3.

    Mellgren A, Johansson C, Dolk A,et al. Enterocele demonstrated by defaecography is associated with other pelvic floor disorders. Int J Colorectal Dis 1994;9:121–4.

  4. 4.

    Kelvin FM, Maglinte DD, Benson JT, Brubaker LP, Smith C. Dynamic cystoproctography: a technique for assessing disorders of the pelvic floor in women. AJR Am J Roentgenol 1994;163:368–70.

  5. 5.

    Arhan P, Devroede G, Jehannin B. Segmental colonic transit time. Dis Colon Rectum 1981;24:625–9.

  6. 6.

    Sullivan ES, Stranburg CO, Sandoz IL, Tarnasky JW, Longaker CJ. Repair of total pelvic prolapse: an overview. In: Shrock T, ed. Perspectives in colon & rectal surgery. St. Louis: Quality Medical Publishing, 1990:119–31.

  7. 7.

    Snooks SJ, Swash M, Henry MM, Setchell M. Risk factors in childbirth causing damage to the pelvic floor innervation. Int J Colorectal Dis 1986;1:20–4.

  8. 8.

    Sultan AH, Stanton SL. Occult obstetric trauma and anal incontinence. Eur J Gastroenterol Hepatol 1997;9:423–7.

  9. 9.

    Norton PA, Baker JE, Sharp HC, Warenski JC. Genitourinary prolapse and joint hypermobility in women. Obstet Gynecol 1995;85:225–7.

  10. 10.

    Makinen J, Soderstrom KO, Kiilholma P, Hirvonen T. Histological changes in the vaginal connective tissue of patients with and without uterine prolapse. Arch Gynecol Obstet 1986;239:17–20.

  11. 11.

    Smith AR. Role of connective tissue and muscle in pelvic floor dysfunction. Curr Opin Obstet Gynecol 1994;6:317–9.

  12. 12.

    Carley ME, Schaffer J. Urinary incontinence and pelvic organ prolapse in women with Marfan or Ehlers-Danlos syndrome. Am J Obstet Gynecol 2000;182:1021–3.

  13. 13.

    Berglass B, Rubin IC. Study of the supportive structures of the uterus by levator myography. Surg Gynecol Obstet 1953;97:672–92.

  14. 14.

    Berglass S, Rubin IC. Histologic study of the pelvic connective tissue. Surg Gynecol Obstet 1957;97:277–89.

  15. 15.

    Norton PA. Pelvic floor disorders: the role of fascia and ligaments. Clin Obstet Gynecol 1993;36:926–38.

  16. 16.

    Sears NP. The fascia surrounding the vagina, its origin and arrangement. Am J Obstet Gynecol 1933;25:484–92.

  17. 17.

    Ulenhuth E, Day EC, Smith DR, Middleton EB. The visceral endopelvic fascia and the hypogastric sheath. Surg Gynecol Obstet 1948;86:9–28.

  18. 18.

    Richter K, Frick H. Die anatomie der fascia pelvic visceralis aus didsktischer sicht. Geburtsh U Frauenheilk 1985;45:282–7.

  19. 19.

    Ulenhuth E, Wolfe WM, Smith EM, Middleton EB. The rectogenital septum. Surg Gynecol Obstet 1948;86:148–63.

  20. 20.

    Ripstein CB. Surgical care of massive rectal prolapse. Dis Colon Rectum 1965;8:34–8.

  21. 21.

    Nigro ND. Restoration of the levator sling in the treatment of rectal procidentia. Dis Colon Rectum 1958;1:123–7.

  22. 22.

    Mellgren A, Bremmer S, Johansson C,et al. Defecography: results of investigations in 2,816 patients. Dis Colon Rectum 1994;37:1133–41.

Download references

Author information

Correspondence to Dr Patrick Y. H. Lee M.D..

About this article

Cite this article

Sullivan, E.S., Longaker, C.J. & Lee, P.Y.H. Total pelvic mesh repair. Dis Colon Rectum 44, 857–863 (2001). https://doi.org/10.1007/BF02234709

Download citation

Key words

  • Pelvic organ prolapse
  • Pelvic floor descent
  • Incontinence
  • Enterocele
  • Rectal prolapse
  • Prosthetic mesh
  • Marlex® mesh
  • Defecation dysfunction