Sedation and local anaesthesia for vaginal pelvic floor repair of genital prolapse using mesh

Abstract

In this study of the surgical repair of pelvic organ prolapse (POP), the vaginal pelvic floor repair with mesh (PFR-Mesh) procedure was used. The procedure is originally named TVM. All 55 patients in the series were operated upon under sedation and local anaesthesia as pain relief. The objectives were twofold. Firstly, the objective was to evaluate peri-operative and immediate post-operative complications. Secondly, the objective was to evaluate the feasibility of performing these relatively complex procedures under sedation and local anaesthesia. The visual analogue scale (VAS) was used to record pain during and after the operations. At a follow-up visit 8–12 weeks post-operatively, a self-instructed questionnaire evaluating subjective opinions of the operation itself and the post-operative period was handed in. Of the 55 patients, anterior, posterior and total PFR-Mesh procedures were performed in 39 (71%), 12 (22%) and 4 (7%) patients, respectively. Mean age was 68 years (52–93). All patients could be operated as scheduled under sedation and local anaesthesia. Mean operative time was 38 min (26–70). Peri-operative complications consisted of two cases of bladder perforation with the superior needle in an anterior repair and vaginal perforation with the inferior needle also in an anterior repair. At the conclusion of the operation VAS was recorded to be 0–3 in 65% of the patients. There were no immediate post-operative complications. Out of 55 patients, 35 (64%) left the ward on the day of operation whilst the remaining 20 (36%) patients stayed for only one night. The safety of the PFR-Mesh procedure and the feasibility of performing these procedures under sedation and local anaesthesia were demonstrated. However, expertise in vaginal surgery is required.