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Laparoscopic complete sacrocolpopexy mesh removal for right-sided gluteal pain and recurrent mesh erosion

  • Aditi Siddharth
  • Rufus Cartwright
  • Simon Jackson
  • Natalia PriceEmail author
IUJ Video

Abstract

Aim of video

The aim was to demonstrate laparoscopic complete excision of sacrocolpopexy mesh from a 65-year-old woman who had presented with delayed onset of persistent right-sided gluteal pain.

Method

The patient was referred to our unit, having undergone a laparoscopic sacrocolpopexy for vault prolapse 7 years earlier, with a type 1 polypropylene mesh. Four years after the primary surgery, she first noticed symptoms of spontaneous vaginal pain together with deep dyspareunia, and right-sided gluteal pain. Clinical examination revealed mesh erosion at the vaginal vault. This was managed at her local hospital, with excision of the small exposed portion of the mesh and over sewing, from a vaginal approach. She continued to be symptomatic following this procedure. When her symptoms still failed to improve 3 years later, a tertiary referral was made to our unit. At laparoscopy, minimal adhesions between the bowel and the mesh were noted and divided. After carefully dissecting the right ureter and reflecting the bladder, the entire sacrocolpopexy mesh was removed with its ProTack fasteners. The entire specimen was retrieved in one piece through the open vault and the vagina was sutured with 2.0 <monocryl laparoscopically. Surgical steps begin with laparoscopic survey of the anatomy. Adhesions need to be released carefully, after developing proper surgical planes. On follow-up in clinic 12 weeks later, there was complete resolution of her symptoms, with minimal vault descent.

Conclusion

This video demonstrates the steps needed to undertake complete laparoscopic sacrocolpopexy mesh excision, which should be feasible for skilled laparoscopists. This approach has advantages over the open approach, with good access and visualisation of the entire course of the mesh, and more rapid recovery for the patient.

Keywords

Laparoscopic sacrocolpopexy Mesh erosion Chronic pelvic pain Mesh excision Mesh complications 

Notes

Compliance with ethical standards

Conflicts of interest

None.

Consent

Written informed consent was obtained from the patient for publication of this video article and any accompanying images.

Supplementary material

192_2019_4088_MOESM1_ESM.mp4 (70.7 mb)
ESM 1 (MP4 72413 kb)

References

  1. 1.
    Nygaard IE, McCreery R, Brubaker L, Connolly AM, Cundiff GW, Weber AM, et al. Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol. 2004;104:805–23.CrossRefPubMedGoogle Scholar
  2. 2.
    Arsene E, Giraudet G, Lucot JP, Rubod C, Cosson M. Sacral colpopexy: long-term mesh complications requiring reoperation(s). Int Urogynecol J. 2015;26:353–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Cundiff GW, Quinlan DJ, van Rensburg JA, Slack M. Foundation for an evidence informed algorithm for treating pelvic floor mesh complications: a review. BJOG Int J Obstet Gynaecol. 2018;25:1026–37.CrossRefGoogle Scholar
  4. 4.
    Chamsy D, Lee T. Laparoscopic excision of sacrocolpopexy mesh. J Minim Invasive Gynecol. 2014;21(6):986.CrossRefPubMedGoogle Scholar
  5. 5.
    Stepanian AA, Miklos JR, Moore RD, Mattox TF. Risk of mesh extrusion and other mesh-related complications after laparoscopic sacral colpopexy with or without concurrent laparoscopic-assisted vaginal hysterectomy: experience of 402 patients. J Minim Invasive Gynecol. 2008;15(2):188–96.CrossRefPubMedGoogle Scholar
  6. 6.
    Mangir N, Roman S, Chapple CR, et al. Complications related to use of mesh implants in surgical treatment of stress urinary incontinence and pelvic organ prolapse: infection or inflammation? World J Urol. 2019.  https://doi.org/10.1007/s00345-019-02679-w.CrossRefPubMedGoogle Scholar
  7. 7.
    South MMT, Foster RT, Webster GD, Weidner AC, Amundsen CL. Surgical excision of eroded mesh after prior abdominal sacrocolpopexy. Am J Obstet Gynecol. 2007;197(6):615.e1–5.CrossRefGoogle Scholar
  8. 8.
    National Institute for Health and Care Excellence. Sacrocolpopexy using mesh to repair vaginal vault prolapse. 2017. https://www.nice.org.uk/guidance/ipg583/resources/sacrocolpopexy-using-mesh-to-repair-vaginal-vault-prolapse-pdf-1899872166977989. Accessed 28 June 2017.
  9. 9.
    Birnbaum SJ. Rational therapy for the prolapsed vagina. Am J Obstet Gynecol. 1973;115:411–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Oliver JL, Chaudhry ZQ, Medendorp AR, et al. Complete excision of sacrocolpopexy mesh with autologous fascia sacrocolpopexy. Urology. 2017;106:65–9.CrossRefPubMedGoogle Scholar

Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.John Radcliffe HospitalOxfordUK

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