Fascia or Fabric: A randomised trial of autologous fascia lata Vs synthetic mesh in vault prolapse

Background: Abdominal Sacrocolpopexy (ASC) is the gold standard surgical procedure for vaginal vault prolapse. Although synthetic mesh provides excellent anatomical support, concerns regarding mesh-related complications have led to renewed interest in biologic grafts such as autologous Fascia Lata.
Objective: To compare the anatomical outcomes and functional results of autologous Fascia Lata versus synthetic polypropylene mesh in abdominal sacrocolpopexy.
Methods: This prospective, single-blinded randomized controlled trial was conducted at a tertiary care center between April 2009 and March 2012. Fifty-eight women with stage 3–4 vaginal vault prolapse were randomized to undergo ASC using autologous fascia lata (n = 28) or synthetic mesh (n = 30). Patients were followed for up to 36 months. Primary outcomes were objective anatomical success based on POP-Q points, and secondary outcomes included operative parameters, complications, and functional outcomes.
Results: The autologous fascia lata group demonstrated significantly superior outcomes at POP-Q points Aa, Ba, Ap, and Bp compared to the mesh group (p < 0.05), while apical support (C point) was comparable. Operative time, blood loss, and hospital stay did not differ significantly between groups. De novo dyspareunia was absent in the fascia lata group but occurred in 28.6% of the mesh group. De novo stress urinary incontinence was more frequent in the fascia lata group.
Conclusion: Autologous fascia lata provides comparable or superior anatomical outcomes with better functional results and avoidance of mesh-related complications, making it a safe and effective alternative to synthetic mesh in abdominal sacrocolpopexy.