(Poster 128) Impact of Body Mass Index on Fascia Lata Graft Harvesting for Sacral Colpopexy

Objectives: The use of fascia lata during a robotic sacral colpopexy (RSC) is a well-described technique for apical prolapse. Given concerns regarding the safety of synthetic mesh, there has been renewed interest in autologous tissue alternatives, such as fascia lata. While prior studies have demonstrated the feasibility and short-term success of fascia lata SCP, there remains a gap in understanding factors that may impact graft procurement. This study aims to identify whether body mass index (BMI) influences fascia lata harvest time or the size of the harvested graft, providing further insight into patient selection and optimization for autologous RSC procedures.

Methods: A retrospective chart review was conducted at three academic hospitals from 2017 to 2024. Patients who underwent RSC with fascia lata were identified. Data collected included BMI, fascia lata harvest time, and graft size. Statistical analysis was performed using Student’s t-test.

Results: A total of 48 patients underwent RSC with the use of fascia lata. Among the 48 patients included, 33 patients had a BMI less than 30.0 kg/m² and 15 patients had a BMI greater than or equal to 30.0 kg/m². The average BMI of the two groups were 25.45 kg/m² and 33.10 kg/m². The mean fascia lata harvest time (min) was longer for BMI ≥30 (20.61 vs 26.00, P = 0.014). The mean fascia lata length (cm) was similar between groups (15.24 vs 14.33, P = 0.341). The mean fascia lata width (cm) was larger in the BMI ≥30 group (4.88 vs. 5.57, P = 0.042).

Conclusions: This study is the first to examine the effect of BMI on fascia lata harvest time and graft size in the setting of RSC. Increased BMI is often thought to be associated with longer dissection times. Our findings indicate that fascia lata harvesting time is longer for patients with a BMI ≥30 by approximately 6 minutes. Additionally, the BMI ≥30 group had an average graft width of nearly a full centimeter more compared to the smaller BMI group. This may contribute to a larger surface area application of the graft leading to a greater durability. This study demonstrates that while graft harvesting requires more time in patients with higher BMI, it can result in a larger graft. Future studies should assess the impact of fascia lata harvest size on residual tissue function and explore other factors influencing fascia lata graft characteristics.