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Medline ® Abstract for Reference 44

of 'Surgical management of posterior vaginal defects'

Clinical practice guidelines on vaginal graft use from the society of gynecologic surgeons.
Murphy M, Society of Gynecologic Surgeons Systematic Review Group
Obstet Gynecol. 2008;112(5):1123.
OBJECTIVE: To develop guidelines regarding whether graft or native tissue repair should be done in transvaginal repair of anterior, posterior, or apical pelvic organ prolapse.
METHODS: The Society of Gynecologic Surgeons formed a work group to develop evidence-based guidelines. Published data from 1950 to November 27, 2007, from the companion systematic review were reviewed to develop guidelines on biologic and synthetic graft use compared with native tissue repair in vaginal prolapse repair. The work group formulated guidelines based on its overall assessment of the evidence. The approach to grading the quality of evidence and the strength of recommendations was based on a modification of the Grades for Recommendation Assessment, Development, and Evaluation system.
RESULTS: It is suggested that native tissue repair remains appropriate when compared with biologic graft use. Nonabsorbable synthetic graft use may improve anatomic outcomes of anterior vaginal wall repair, but there are trade-offs in regard to additional risks. The group suggests issues that should be included in the preoperative counseling of patients in whom clinicians propose to use a vaginally placed graft.
CONCLUSION: Based on the overall low quality of evidence, only weak recommendations could be provided. This highlights the need for practitioners to fully explain the relative merits of each alternative and carefully consider patients' values and preferences to arrive at an appropriate decision. Future research is likely to change the estimates in the net benefit and risk and the confidence around these assessments.
Society of Gynecologic Surgeons Systematic Review Group, Institute for Female Pelvic Medicine&Reconstructive Surgery, North Wales, PA 19454, USA. milesmurphy@comcast.net