Mesh Erosion After Abdominal Sacral Colpopexy

ABSTRACT Background: Abdominal sacral colpopexy is an important operation in managing posthysterectomy vaginal vault prolapse and total uterine procidentia. There are few reported series with sufficient patient numbers and duration of follow up that can meaningfully address uncommon complications. Synthetic materials are frequently, and for some operators usually, employed. In this series of 375 abdominal sacral colpopexies during a 23-year interval, 12 patients were encountered who have had mesh erosions through the vaginal mucosa. Mesh erosions were managed in four patients referred to us. One patient in this series had mesh erode into the bladder. It is the purpose of this article to report the management of these patients.
Cases: Fourteen patients were seen principally with the symptom of blood-tinged vaginal discharge, which also may have been malodorous. Three patients were asymptomatic. Examinations revealed either exposed mesh in the upper vagina or in the vaginal sinus tracts. The patient with eroded mesh in her bladder had repetitive bladder infections only. Nine patients underwent successful transvaginal resection of the eroded mesh, and repeat transvaginal resections were performed in seven. The patient with bladder mesh underwent a combined transabdominal/vaginal resection, but she has since had recurrent vesical erosion. A right adnexal complex mass developed in one patient who had had two previous transvaginal resections of eroded mesh. A laparotomy with right salpingo-oophorectomy and a transabdominal resection of her suspensory mesh with removal from the sacrum accompanied by intraoperative hemorrhage were performed.
Conclusions: Synthetic suspensory materials can erode through adjacent tissues and organs. This complication can be managed conservatively in most patients, allowing most of the suspensory material to be left in place and provide continued vaginal support, avoiding potential severe hemorrhage that can result from attempts to remove mesh from the sacrum.
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