Pelvic organ prolapse is a common condition affecting women, characterized by the descent of pelvic organs into or through the vaginal canal. Sacrocolpopexy is a surgical procedure employed to correct this condition, traditionally using a synthetic mesh. However, during the last decades, the potential risk of erosion and infection of the implanted material has been criticized by both patients and medical professionals, leading to negative perceptions commonly referred to as "mesh-bashing." This has prompted interest in alternative materials, such as autologous fascia lata, to mitigate these risks and offer other options.

We present a case of a 40-year-old woman with a history of laparoscopic gastric bypass and ovarian cyst resection who had grade III uterine prolapse and secondary cystocele, leading to bladder emptying issues. Urodynamic tests showed bladder outlet obstruction - with residue - without the correction of her prolapse. However, there was normal bladder emptying with no residue with a vaginal ring. She was intolerant to a pessary and worried about a synthetic mesh due to her desire for pregnancy. We recommended a robot-assisted anterior sacrocolpopexy using fascia lata. Informed consent was obtained for the procedure and the publication of the case report.

The procedure can be divided into two parts: firstly, the harvesting of the fascia lata, and secondly, the intra-abdominal robot-assisted intervention for the anterior sacrocolpopexy.

The harvesting was performed with the patient in a supine position, ensuring optimal visualization of the lateral thigh. The anatomical landmarks were marked, including the lateral condyle of the tibia, where the iliotibial band inserts. Furthermore, the edges of the fascia lata were outlined. The incision started 10cm above the insertion point on the tibia. The - in this case 10cm - incision was followed by dissection down to the fascia. The fascia was then marked and harvested (in here: 10x4cm). Afterwards, the fascia was again approximated and the skin was closed in a traditional manner.

The second part involved the robot-assisted segment. Following standard procedure, the promontory was dissected free, as well as the posterior peritoneum. The bladder was dissected away from the anterior vaginal wall. The harvested fascia lata was sutured to the anterior vaginal wall using polyester non-absorbable sutures. The mesh was passed through the broad ligament to the promontorium at the desired tension and then secured with the same suture as previously used. The procedure was concluded with the closure of the peritoneum.

There were no peroperative complications and minimal blood loss. The harvesting itself took approximately 20 minutes. The urinary catheter was removed on the first postoperative day. The patient experienced minimal pain, both abdominally and at the upper thigh. She was able to go home at the second postoperative day. During follow-up, the patient was satisfied, with full resolution of the prolapse and bladder emptying disorder.

The use of autologous fascia lata in anterior sacrocolpopexy presents a viable alternative to synthetic mesh implants, addressing concerns related to mesh-related complications and meeting patient preferences for natural tissue repair. This case demonstrates the procedure's feasibility and safety, with no perioperative complications and favorable postoperative outcomes, including patient satisfaction, clinical effectiveness, and minimal leg discomfort. The technique offers a promising solution for patients wary of synthetic materials and underscores the importance of personalized surgical approaches in pelvic organ prolapse management.

Continence 12S (2024) 101521
DOI: 10.1016/j.cont.2024.101521