Tissue Fixation System ligament repair cures major pelvic organ prolapse in ageing women with minimal complications – a 10-year Japanese experience in 960 women

INTRODUCTION: Japan’s ageing crisis has brought major prolapse and incontinence problems. We hypothesized the problem was collagen leaching out of ligaments which support organs and could be corrected by the TFS (Tissue Fixation System) minisling which uses 7 mm wide tapes to create new collagen for ligament reinforcement. We analysed our 10-year experience (2009–2019) with TFS minisling prolapse repair with regard to one main question: “Is this technology of benefit to the ageing Japanese population?”. MATERIAL AND METHODS: Retrospective analysis from two tertiary referral units; 3100 tapes were implanted (variously) into cardinal, uterosacral, arcus tendineus fascia pelvis (ATFP), perineal body ligaments of 960 Japanese women (mean age 69.6 years), to repair POPQ 3(rd) or 4(th) degree prolapse (918/960), 50% under local anesthesia/sedation, remainder general/spinal anesthesia. RESULTS: Patient discharge within 24 hours indicated minimal intra-operative problems. Prolapse cure at 12 months reached 90%. Complications requiring intervention were infected rectal perforation by tape, 3 delayed ileus complications. Eroded tapes (2.4–3.5%) were trimmed in the clinic. De novo long-term pain and major urine loss were virtually absent. CONCLUSIONS: The TFS system works by restoring ligament support (pubourethral, ATFP, cardinal, uterosacral, perineal body), differently from mesh sheets which work by blocking organ descent, which can lead to fibrosis of the vagina, and may cause chronic pain and massive incontinence. We had no such problems, because tapes have small volume, are applied transversely, with little vaginal contact. Specific ligament reinforcement with collagenopoietic tapes seems to be an important new direction for aged women with major prolapse, with high cure rate, acceptable complications, low erosions and virtually no long-term pain.