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Mesh Complication Case Study #28

Sacral Colpopexy Mesh Abscess and Mesh Extrusion

Initial Mesh Surgery: Laparoscopic sacral colpopexy in 2002. The mesh utilized was silicone impregnated solft polypropylene. This mesh is no longer being sold in the U.S.A.

Post Mesh Surgery Symptoms: Pus draining form the vagina; severe vaginal and lower abdominal pain; inability to have sex; symptoms began 8 years after original surgery

Treatment to Repair Mesh Complications: Laparoscopic adhesiolysis (scar takedown) and laparoscopic removal.

Patient is a 56-year-old who had surgery by her general gynecologist for cystocele and rectocele 3 years ago.  She had Avaulta Mesh Repair for her rectocele and TOT sling for incontinence.  

This patient is a 54 year old female who was originally operated on by Dr. Miklos in 1999 at which time she had a hysterectomy (for uterine prolapse); uterosacral vault suspension ( for the deepest part of the vagina prolapsing); paravaginal  repair (for cystocele) and a posterior repair (for repair of rectocele).  The patient did fine for approximately 2 years at which time she returned to see Dr. Miklos for symptoms of vaginal prolapse again.  The exam confirmed that the vault was falling down (ie vaginal vault prolapse).  The patient was offered a sacral colpopexy.

After an informed consent was obtained the patient was taken to the operating room where a sacral colpopexy was performed.

The patient did well for 8 years until July 2011 at which time she saw her gynecologist who referred her to a gynecologic oncologist (cancer surgeon).  The gynecologic oncologist referred her back to Dr. Miklos to address the problem.  The patient was taken to the operating room only 1 week later where the mesh was removed through miniature abdominal incision (i.e. laparoscopic).  Figure 2 shows the dissection of the mesh away from the vagina, Figure 3 shows the detachment at the sacrum and Figure 4 shows the mesh removed from the patient’s body.  Though there is no 100% guarantee that it will take away the pain most patient do very well with removal of the mesh.  

This patient is only a few weeks out and has not had a recurrence of pus formation or chronic pain in the vagina at this point; however she has yet to engage in intercourse.

Figure 1
Figure 1 – Mesh covered with peritoneum (the skin lining the abdominal cavity)
Figure 2
Figure 2 - The mesh is seen in the middle of the picture and has been dissected off of the tailbone
Figure 3
Figure 3 - The mesh is again seen in the middle of the picture with both instruments being utilized to remove the sutures that are holding the mesh to the vagina
FIgure 4
Figure 4 - The mesh is being held horizontally by two instruments. This picture was taken to show the viewer the length/size of the mesh and how the whole mesh was removed from the sacrum to the vagina.
Figure 5
Figure 5 - The mesh removed from the patient's body cavity.

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