Laparoscopic removal of pubovaginal polypropylene tension-free tape slings

Complications of polypropylene pubovaginal tension-free tape slings (TVT, SPARC, and others), such as erosion into the bladder or chronic pain attributed to the mesh sling are rare events; however, when they occur, it may necessitate removal of the sling. To date, removal through a laparotomy incision or by operative cystoscopy has been the most common approach. We present 5 cases of a laparoscopic approach for removal of polypropylene pubovaginal tension-free tape slings.

We report 5 cases of laparoscopic removal of TVT mesh. Three were removed for mesh erosion into the bladder, and 2 were removed secondary to the patients having persistent pain and discomfort attributed to the sling. An intraperitoneal approach was used to enter the retropubic space to remove the sling. Dissection was completed with a Harmonic scalpel blade as well as blunt dissection to identify the mesh sling retropubically. Average operating time was 104 minutes. Average blood loss was 70 mL. Average hospital stay was <23 hours. Postoperative courses were uneventful; however, 4 of the 5 patients continue to have urgency and frequency symptoms following sling removal.

These cases illustrate the use of laparoscopy in the removal of polypropylene pubovaginal tension-free tape slings for bladder erosion or persistent pain, or both, attributed to the sling. Erosion and pain are known complications of polypropylene pubovaginal slings and may cause significant morbidity like persistent detrusor instability or urge incontinence, or both. Patients must be informed of these risks and possible complications before making their decision to undergo surgery.