Perigee System for The Management of Cystocele: Our Initial Experience of 40 cases Dr Abhay Anand, Dr Krishnamohan R, Dr Harigovind P, Calicut, Kerala Introduction: The Perigee system uses polypropylene mesh placed without tension via strips through the obturator foramen. The obturator route appears to be easy, safe and effectual for mesh interposition. According to recent reports this technique is accompanied by low perioperative risks and high success rates. In this study we report our initial 3 year experience, efficacy and complications of the Perigee procedure for the Cystocele correction Methods : All patients who underwent Cystocele repair with the Perigee system between May 2012 and May 2015 at our institution were included in the study.Patients who presented to our hospital with a symptomatic stage 2 or above Cystocele were included Cystocele was classified with the Pelvic Organ Prolapse Quantitation(POPQ). The study involved a POPQ assessment pre- and post-operatively .We estimated operating time , hospital stay, intra and post op complications Results a total of 40 women were involved in the study.The mean operative time was 61.63, minutes mean hospital stay was 1.13 days.There were no life-threatening complications Genital discomfort was the most common complication. None were found to have mesh extrusion/infection. There was no recurrence of Cystocele on follow-upDiscussion. The vaginal graft PERIGEE system using transobturator approach repairs all types of anterior vaginal wall defects (proximal, distal, central and lateral).Bilateral superior and inferior needles allows minimal lateral dissection and reduce the blood loss and other healing abnormalities. Risks of lower urinary tract and obturator nerve/vessel injury is exceptionally low. Perigee has high success rate and no recurrence of vaginal wall prolapse as reported in recent studies and in our study.According to some investigators vaginal mesh erosions continue to be the serious problems occurring in 2 to 13%. However in our study no patient had vaginal erosion Conclusion. In our 3 year experience the Perigee system for the treatment of Cystocele is deemed safe with no recurrence and acceptable risks. In our series the Perigee system showed good efficacy and safety results, Low morbidity, no mortality, less hospital stay and recovery time.