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.
References
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.
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.
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.
Chamsy D, Lee T. Laparoscopic excision of sacrocolpopexy mesh. J Minim Invasive Gynecol. 2014;21(6):986.
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.
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.
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.
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.
Birnbaum SJ. Rational therapy for the prolapsed vagina. Am J Obstet Gynecol. 1973;115:411–9.
Oliver JL, Chaudhry ZQ, Medendorp AR, et al. Complete excision of sacrocolpopexy mesh with autologous fascia sacrocolpopexy. Urology. 2017;106:65–9.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None.
Consent
Written informed consent was obtained from the patient for publication of this video article and any accompanying images.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
ESM 1
(MP4 72413 kb)
Rights and permissions
About this article
Cite this article
Siddharth, A., Cartwright, R., Jackson, S. et al. Laparoscopic complete sacrocolpopexy mesh removal for right-sided gluteal pain and recurrent mesh erosion. Int Urogynecol J 31, 411–413 (2020). https://doi.org/10.1007/s00192-019-04088-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-019-04088-4