Dr. John Miklos and Dr. Robert Moore – Vaginal Mesh Complication Surgeons

Internationally Renowned Vaginal and Laparoscopic Surgeons

Located in Atlanta, GA – Patients from 47 States and 45 Countries

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Mesh Complication Case Study #24

Sacral Colpopexy Mesh Abscess (Y – Mesh Graft)

Type I Polpyropylene Y- mesh Graft

Initial Mesh Surgery: Laparoscopic approach to abscess evacuation and sacral colpopexy mesh removal following hysterectomy

Post Mesh Surgery Symptoms: Vaginal and lower abdominal pain 10 days after her laparoscopic assisted vaginal hysterectomy (LAVH) and sacral colpopexy procedure

Surgery to Repair Mesh Complications:  Laparoscopic abscess evacuation and Y- mesh removal of the sacral colpopexy mesh.

Patient is a 47-year-old female who initially had a reconstructive vaginal surgery for uterine vaginal prolapse.  She had a laparoscopic assisted vaginal hysterectomy for her uterine prolapse, laparoscopic sacral colpopexy for vaginal vault prolapse, laparoscopic paravaginal repair for a cystocele and a posterior repair for her rectocele.  The patient’s uterus had been prolapsing beyond the vaginal opening for more than a year before she decided to have the above surgery.  The AMS Y-shaped mesh (see picture below) was used to do the sacral colpopexy. This mesh is a Type I macroporous polypropylene mesh (similar to Gynemesh) and is the standard mesh utilized in Sacralcolpopexy with the lowest rates of complications.

8 days after having the above surgery she began to experience some lower abdominal, pelvic and vaginal pain as well as fever.  She was placed on intravenous antibiotic therapy and a CT scan was ordered.  The CT scan confirmed a vaginal cuff/apex abscess.  Dr. Miklos decided on removing the mesh at that time. 

Y-shaped Mesh

Using the previous incision sites, Dr. Miklos and Moore approached the mesh removal laparoscopically. 

They entered the abdominal cavity and first had to take down adhesions.

They then opened up the peritoneum covering the mesh at the level of the tailbone/sacrum.  A green suture can be seen attaching the mesh to the sacral prominence..

These sutures were individually removed as well as the sutures attaching the mesh to the vagina..

The mesh was completely removed from the sacrum and the vagina and the mesh is seen here still
within the abdominal cavity (left) and outside the body (right). 

Dr. Miklos and Moore Comment: The above complication was most likely due to an abscess or infection following hysterectomy and could have happened if the mesh was present or not. Rates of cuff abscesses following hysterectomy are in the range of <1%, however if it occurs and a mesh sacralcolpopexy was completed at the time of hysterectomy for prolapse the mesh may need to be removed in order to treat the infection. Dr. Miklos and Moore recently published the worlds LARGEST series on Laparoscopic Mesh Sacralcolpopexy with over 400 patients utilizing the same type of mesh and the overall rates of complications were not significantly different whether a hysterectomy was completed at the time of the sacralcolpopexy or not.  In that series, they only had to remove one mesh due to an infection and it did occur in a patient that had a concomitant hysterectomy. It is important to note that this is the standard, accepted type of mesh that is used for sacralcolpopexy and has been shown to be safe and effective in many studies. The recent FDA notification excluded this type of mesh placement from their announcement (meaning that the warning was in regards to this type of mesh placement). Unfortunately, however, risks are associated with any type of surgery and the most important factor is having surgeons that recognize any complication early and have the experience to treat them as well.

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