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

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Mesh Complication Case Study #26

TVT Sling and Posterior Wall Mesh Complication

Surgery:  TVT Sling, Posterior repair w/ mesh

Symptoms:  Recurrent prolapse, persistent urinary leakage, mesh extrusion

Findings: Mesh balled up and extruded through vagina (providing no support), TVT sling through the sigmoid colon

Surgery:  Patient is a 62 year old who had surgery 5 yrs ago which included TVT sling for stress urinary leakage (SUI) and a Posterior repair with mesh graft (no kit) for rectocele.

Her original surgery included:

TVT sling
Posterior repair with Gynemesh

DR. MOORE and DR. MIKLOS SURGERY: Laparoscopic/vaginal removal of old mesh, new TVT sling, Remove OLD TVT sling going through bowel (Bowel Resection) and Laparoscopic sacralcolpopexy

Symptoms  - Patient presented with symptoms of persistent urinary leakage with laugh, cough, sneeze (stated sling never really worked) and a large bulge vaginally causing pressure and discomfort.  She had a prior repair many years ago with a hysterectomy and “bladder tack”.  She stated that the more recent surgery worked for a period of time for the prolapse, but never really for her SUI.  Her symptoms of pain were secondary to prolapse and bulge, not mesh.

Treatment- The patient came in to see Dr. Moore and Miklos and was found to have a large rectocele as well as the posterior wall mesh bunched up (providing no support) into a ball on one side of the vagina and it had also extruded out of the vaginal skin.  She additionally had a large rectocele and vaginal vault prolapsed. Stress urinary incontinence was confirmed on exam as well.

Dr. Moore and Miklos took her to surgery to remove the previous placed mesh and repair the prolapsed and incontinence. If the mesh was not causing any problems, it could have been left in place and then more just added laparoscopically to correct the problem, however secondary to its position and the fact it was extruding out of the vagina, it needed removed.  Additionally, they recommended a repeat TVT sling under local anesthesia at beginning of case with cough test to tighten it until she didn’t leak with cough.

The new TVT was completed at the beginning of the case and the patient put to sleep after adjustment.  A laparoscopic approach was then utilized to both repair her prolapse (with Mesh Sacralcolpopexy) and do part of the mesh removal laparoscopically. Upon entry into the abdomen they found that her OLD TVT sling was going THROUGH the large intestine (See Pictures below ). This could not be left like this, therefore the sling was removed via resection of the piece of bowel that it was going through and then the bowel put back together (Sigmoid Bowel Resection).

The old mesh was then encountered on the back of the vagina laparoscopically and it was dissected free from above and then removed through a vaginal incision. Secondary to the clean nature of the case, the sacralcolpopexy was still able to be completed and the patient did very well post-operatively with no infection, normal return of bowel function, no urinary leakage and excellent vaginal support!

This is a VERY complex case and one that only advanced laparoscopic/pelvic surgeons should entertain.

 

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