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Complications of Abdominal Sacrocolpopexy

  • Michelle Koski
  • J. Christian WintersEmail author
Chapter
Part of the Current Clinical Urology book series (CCU)

Abstract

With the aging of our population, pelvic organ prolapse is an increasingly common condition that negatively affects patient quality of life. Vaginal vault prolapse has been reported to occur in as many as 18.2% of all women with prolapse [1], and many would suggest that vaginal vault prolapse is a component of most high-grade anterior compartment descensus. Several repairs exist that reconstitute support to the vaginal vault, and certainly there is no single procedure that is optimal for all patients. Abdominal sacral colpopexy (ASC) offers an effective and durable repair for vaginal vault prolapse [2]. It maximizes functional vaginal length and approximates the normal vaginal axis [3]. ASC should be considered especially in patients with failed prior vaginal repairs, isolated high-grade apical prolapse, and in younger patients with apical prolapse who would like to maintain sexual function [4]. The procedure may be performed open, laparoscopically, or robotically. In our experience, the key components of the operation though the open or robotic approach include utilization of a permanent, type I macroporous mesh, secure suture fixation of the graft to the sacral promontory and vaginal cuff (Fig. 6.1), complete enterocele reduction and culdoplasty, and the addition of concomitant anti-incontinence procedures as indicated [4]. We affix the vaginal portion of the graft with multiple sutures to distribute the tension evenly over the vaginal apex (Fig. 6.2), and avoid excessive tension between the apex and sacrum (Fig. 6.3). We routinely close the peritoneum over the mesh arm. In this chapter we will address the recognition and management of complications potentially associated with this method of the repair, as well as outline complications that have arisen from other variations.

Keywords

Degenerative Disc Disease Mesh Erosion Sacral Promontory Vaginal Vault Prolapse Apical Prolapse 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Winters JC, Cespedes RD, Vanlangendonck R. Abdominal sacral colpopexy and abdominal enterocele repair in the management of vaginal vault prolapse. Urology. 2000;56:55–63.PubMedCrossRefGoogle Scholar
  2. 2.
    Nygaard IE, McCreery R, Brubaker L, et al. Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol. 2004;104:805–23.PubMedCrossRefGoogle Scholar
  3. 3.
    Given FT. Vaginal length and sexual function after colpopexy for complete uterovaginal eversion. Am J Obstet Gynecol. 1993;169:284–7.PubMedGoogle Scholar
  4. 4.
    Winters JC, Delacroix Jr S. Abdominal Sacral Colpopexy. In: Graham SD, Keane TE, editors. Glenn’s urologic surgery. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2010. p. 349–54.Google Scholar
  5. 5.
    Birnbaum SJ. Rational therapy for the prolapsed vagina. Am J Obstet Gynecol. 1973;115:411–9.PubMedGoogle Scholar
  6. 6.
    Sutton GP, Addison WA, Livengood III CH, et al. Life-threatening hemorrhage complicating sacral colpopexy. Am J Obstet Gynecol. 1981;140:836–7.PubMedGoogle Scholar
  7. 7.
    Timmons MC, Kohler MF, Addison WA. Thumbtack use for control of presacral bleeding with description of an instrument for thumbtack application. Obstet Gynecol. 1991;78:313–5.PubMedGoogle Scholar
  8. 8.
    Lane FE. Modified technique of sacral colpopexy. Am J Obstet Gynecol. 1982;142:933.PubMedGoogle Scholar
  9. 9.
    Yamamoto Y, Nishimura K, Ueda N, et al. Vesicovaginal fistula caused by abdominal hysterectomy and sacrocolpopexy with polypropylene mesh (Gynemesh): a case report. Hinyokika Kiyo. 2010;56:517–20.PubMedGoogle Scholar
  10. 10.
    Kohli N, Walsh PM, Roat TW, et al. Mesh erosion after abdominal sacrocolpopexy. Obstet Gynecol. 1998;92:999–1004.PubMedCrossRefGoogle Scholar
  11. 11.
    Baessler K, Leron E, Stanton SL. Sacrohysteropexy and sacrocolpopexy. In: Stanton SL, Zimmern P, editors. Female pelvic reconstructive surgery. New York: Springer; 2002. p. 189–90.Google Scholar
  12. 12.
    Brizzolara S, Pillai-Allen A. Risk of mesh erosion with sacral colpopexy and concurrent hysterectomy. Obstet Gynecol. 2003;102:306–10.PubMedCrossRefGoogle Scholar
  13. 13.
    Govier FE, Kobashi KC, Kozlowski PM, et al. High complication rate identified in sacrocolpopexy patients attributed to silicone mesh. Urology. 2005;65:1099–103.PubMedCrossRefGoogle Scholar
  14. 14.
    Cundiff GW, Varner E, Visco AG, et al. Risk factors for mesh/suture erosion following sacrocolpopexy. Am J Obstet Gynecol. 2008;199:688.e1–5.Google Scholar
  15. 15.
    Bensinger G, Lind L, Lesser M, et al. Abdominal sacral suspensions: analysis of complications using permanent mesh. Am J Obstet Gynecol. 2005;193:2094–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Fitzgerald MP, Mollenhauer J, Bitterman P, Brubaker L. Functional failure of fascia lata allografts. Am J Obstet Gynecol. 1999;181:1339–46.PubMedCrossRefGoogle Scholar
  17. 17.
    Fitzgerald MP, Edwards SR, Fenner D. Medium-term followup on use of freeze-dried, irradiated donor fascia for sacrocolpopexy and sling procedures. Int Urogyn J. 2004;15:238–42.Google Scholar
  18. 18.
    Quiroz LH, Gutman RE, Shippey S, et al. Abdominal sacrocolpopexy: anatomic outcomes and complications with pelvicol, autologous, and synthetic graft materials. Am J Obstet Gynecol. 2008;198:557.e1–5.Google Scholar
  19. 19.
    Claerhout F, De Ridder D, Van Beckevoort D, et al. Sacrocolpopexy using xenogenic acellular collagen in patients at increased risk for graft-related complications. Neurourol Urodyn. 2010;29(4):563–7.PubMedGoogle Scholar
  20. 20.
    Quiroz LH, Gutman RE, Fagan MJ, et al. Partial colpocleisis for the treatment of sacrocolpopexy mesh erosions. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:261–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Visco AG, Weidner AC, Barber MD, et al. Vaginal mesh erosion after abdominal sacral colpopexy. Am J Obstet Gynecol. 2001;184:297–302.PubMedCrossRefGoogle Scholar
  22. 22.
    Culligan PJ, Murphy M, Blackwell L, et al. Long-term success of abdominal sacral colpopexy using synthetic mesh. Am J Obstet Gynecol. 2002;187:1473–82.PubMedCrossRefGoogle Scholar
  23. 23.
    Wu JM, Wells EC, Hundley AF, et al. Mesh erosion in abdominal sacral colpopexy with and without concomitant hysterectomy. A J Obstet Gynecol. 2006;194:1418–22.CrossRefGoogle Scholar
  24. 24.
    Patsner B. Mesh erosion into the bladder after abdominal sacral colpopexy. Obstet Gynecol. 2000;95:1029.PubMedCrossRefGoogle Scholar
  25. 25.
    Frenkl TL, Rackely RR, Vasavada SP, et al. Management of iatrogenic foreign bodies of the ­bladder and urethra following pelvic floor surgery. Neurourol Urodyn. 2008;27:491–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Rose S, Bunten CE, Geisler JP, et al. Polypropylene mesh erosion into the bowel and vagina after abdominal sacral colpopexy. J Pelvic Med Surg. 2006;12:45–7.CrossRefGoogle Scholar
  27. 27.
    Kenton KS, Woods MP, Brubaker L. Uncomplicated erosion of polytetraflouroethylene grafts into the rectum. Am J Obstet Gynecol. 2002;187:233–4.PubMedCrossRefGoogle Scholar
  28. 28.
    Hopkins MP, Rooney C. Entero-mesh vaginal fistula secondary to abdominal sacrocolpopexy. Obstet Gynecol. 2004;103:1035–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Pilsgaard K, Mouritsen L. Follow-up after repair of vaginal vault prolapse with abdominal colposacropexy. Acta Obstet Gynecol Scand. 1999;78:66–70.PubMedCrossRefGoogle Scholar
  30. 30.
    Whitehead WE, Bradley CS, Brown MB, et al. Gastrointestinal complications following abdominal sacrocolpopexy for advanced pelvic organ prolapse. Am J Obstet Gynecol. 2007;197:78.e1–7.Google Scholar
  31. 31.
    Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology. 1992;77:162–84.PubMedCrossRefGoogle Scholar
  32. 32.
    Addison WA, Timmons MC, Wall LL, et al. Failed abdominal sacral colpopexy: observations and recommendations. Obstet Gynecol. 1989;74:480–3.PubMedGoogle Scholar
  33. 33.
    Visco AG, Brubaker L, Nygaard I, et al. The role of preoperative urodynamic testing in stress-continent women undergoing sacral colpopexy: the Colpopexy and Urinary Reduction Efforts (CARE) randomized surgical trial. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:607–14.PubMedCrossRefGoogle Scholar
  34. 34.
    Brubaker L, Cundiff GW, Fine P, et al. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. New Engl J Med. 2006;354:1557–66.PubMedCrossRefGoogle Scholar
  35. 35.
    Weidner AC, Cundiff GW, Harris RL, et al. Sacral osteomyelitis: an unusual complication of abdominal sacral colpopexy. Obstet Gynecol. 1997;90:689–91.PubMedCrossRefGoogle Scholar
  36. 36.
    Cranney A, Feibel R, Toye BW, et al. Osteomyelitis subsequent to abdominal-vaginal sacropexy. J Rheumatol. 1994;21:1769–70.PubMedGoogle Scholar
  37. 37.
    Cailleux N, Daragon A, Laine F, et al. Spondylodiscites infetieuses après cure de prolapses genital: A propos de 5 cas. J Gynecol Obstet Biol Reprod. 1991;20:1074–8.Google Scholar
  38. 38.
    Nosseir SB, Kim YH, Lind LR, et al. Sacral osteomyelitis after robotically assisted laparoscopic sacral colpopexy. Obstet Gynecol. 2010;116:513–5.PubMedCrossRefGoogle Scholar
  39. 39.
    Muffly TM, Diwadkar GB, Paraiso MF. Lumbosacral osteomyelitis after robot-assisted total laparoscopic hysterectomy and sacral colpopexy. Int Urogynecol J Pelvic Floor Dysfunct. 2010;21:1569–71.CrossRefGoogle Scholar
  40. 40.
    Hart SR, Weiser EB. Abdominal sacral colpopexy mesh erosion resulting in a sinus tract formation and sacral abscess. Obstet Gynecol. 2004;103:1037–40.PubMedCrossRefGoogle Scholar
  41. 41.
    Taylor GB, Moore RD, Miklos JR. Osteomyelitis secondary to sacral colpopexy mesh erosion requiring laminectomy. Obstet Gynecol. 2006;107:475–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of UrologyMedical University of South CarolinaCharlestonUSA
  2. 2.Department of UrologyLouisiana State UniversityNew OrleansUSA

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