An insight into Novel technique of laparoscopic mid-urethral autologous rectus fascial sling for management of stress urinary incontinence

The safety of vaginal mesh tapes for stress urinary incontinence (SUI) has been the subject of serious concerns. Autologous rectus fascial sling and the more modern "sling on a string" via laparotomy are becoming more and more common as native tissue options for SUI. 

The researchers of the study presented a new method for treating SUI using a laparoscopic mid-urethral autologous rectus fascial sling (LMAFS). The technique included a 4-cm transverse incision in the lower abdomen to harvest a 6 × 2 cm strip of rectus fascia, which was then sutured closed with absorbable 0-braided polyglactin suture on a 40-mm needle. The fascia was secured at one end and continuously sutured from the other end, after securing the other angle. The sutures were carefully spaced one centimetre apart, and the bites were made half a centimetre from the rectus fascial edge. 

After the application of local anesthesia, a sling was created using permanent sutures attached to both ends. A vaginal incision was made near the external urethral meatus, and para-urethral tunnels were created. Following laparoscopic entry, the retropubic space was accessed, and the endopelvic fascia was perforated under laparoscopic guidance. The sling was then positioned and secured to Cooper's ligaments after adjusting for tension. Finally, the vaginal incision was closed with absorbable sutures, and cystoscopy was performed to ensure bladder and urethral integrity.

This innovative approach was safely applied to ten patients. The researchers encountered no trouble either harvesting the rectus fascial sling or closing the rectus fascia using LMAFS technique. The duration of operation was between 90 and 150 minutes. Following 24 hours post-surgery, all women were sent home after they had resumed normal voiding. There were no documented perioperative problems and none of the patients experienced an incisional hernia at the site of harvest. At the 12-month follow-up, all patients reported a complete cure of their SUI symptoms without any wound-associated complications.

Thus, this study showcases a novel surgical technique for treating SUI using LMAFS, highlighting its feasibility and intraoperative safety.  The advantages of this technique include a minimal access approach, the ability to place sutures under laparoscopic guidance, and the prevention of over-tightening of the sling. It also warrants the need for future research with a larger sample size to assess the medium- and long-term safety and outcomes of this approach in managing SUI.

Source: Fayyad AM, Hasan MR. Novel technique of laparoscopic mid-urethral autologous rectus fascial sling for stress urinary incontinence. BJOG. 2024 Nov;131(12):1587-1590. doi: 10.1111/1471-0528.17877. Epub 2024 May 29. PMID: 38812080.