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Published on: September 11, 2021
Appendiceal adhesion to synthetic mesh after laparoscopic sacrocolpopexy: a case report
Roberto Vargas1, Anna Keryan, Vatche A Minassian
1Department of Urogynecology, Brigham and Women's Hospital, 500 Brookline Ave 500B-Suite E, Boston, MA, 02114, USA.
Abstract:
Minimally invasive alternatives to abdominal sacrocolpopexy have been shown to be equivalent with low overall complication rates. A small number of direct mesh-related gastrointestinal complications have been reported in the literature. Sacrocolpopexy with mesh retroperitonealization is recommended to minimize bowel adhesions. A 53-year-old nulligravid woman presented with persistent right lower-quadrant pain 1 year after laparoscopic sacrocolpopexy. The polypropylene mesh used during the case was retroperitonealized. Computed tomography (CT) prior to surgical exploration revealed no obvious pathology. On diagnostic laparoscopy, appendiceal adhesion to mesh requiring an appendectomy was observed. The patient's symptoms resolved after surgical intervention. Appendiceal adhesion to surgical mesh leading to chronic discomfort is a potential complication of intraperitoneal synthetic mesh placement. Our case emphasizes that bowel adhesions may occur even after proper mesh retroperitonealization. Appendiceal adhesion to the surgical site is a potential complication of retroperitonealized synthetic mesh placement at the time of sacrocolpopexy.
Insights
Even with mesh retroperitonealization during sacrocolpopexy, appendiceal adhesion to surgical mesh can occur, causing pain. Surgical intervention resolved the patient's symptoms in this case study.
Area of Science:
- Urogynecology
- Minimally Invasive Surgery
- Surgical Complications
Background:
- Minimally invasive sacrocolpopexy offers an alternative to abdominal approaches with comparable outcomes and low complication rates.
- Mesh-related gastrointestinal complications are rare but documented following sacrocolpopexy.
- Mesh retroperitonealization is a technique recommended to reduce the risk of bowel adhesions.
Observation:
- A 53-year-old woman experienced persistent right lower quadrant pain one year post-laparoscopic sacrocolpopexy.
- The polypropylene mesh used had been retroperitonealized.
- Preoperative CT scans showed no abnormalities; however, diagnostic laparoscopy revealed appendiceal adhesion to the mesh.
Findings:
- Appendiceal adhesion to the retroperitonealized polypropylene mesh was identified as the cause of the patient's chronic pain.
- An appendectomy was performed to release the adhesion.
- The patient's symptoms resolved completely following the surgical intervention.
Implications:
- This case highlights that bowel adhesions, specifically appendiceal adhesion to mesh, can occur even when mesh retroperitonealization techniques are employed during sacrocolpopexy.
- It underscores the importance of considering mesh-bowel adhesions in the differential diagnosis of chronic abdominal pain following synthetic mesh placement.
- Further vigilance and potentially modified surgical techniques may be needed to minimize the risk of such complications.
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