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Updated: Apr 12, 2026
Transvaginal Mesh Insertion in the Ovine Model
Published on: July 27, 2017
The significant morbidity of removing pelvic mesh from multiple vaginal compartments
Stephanie D Pickett1, Benjamin Barenberg, Lieschen H Quiroz
1Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
Objective:
To investigate perioperative complications of mesh removal performed in the operating room from a single-site, tertiary care center with a large volume of referrals for mesh removal and to compare the morbidity associated with single-compartment mesh removal compared with removal from multiple vaginal compartments.
Methods:
A retrospective review was performed on all patients who underwent mesh removal from January 2008 to April 2014. Patients were identified based on Current Procedural Terminology codes for removal of vaginal mesh or sling. Summary statistics were calculated for the patient population. Complications were compared between single-compartment mesh removal surgery and multicompartment mesh removal surgery. A P value of <.05 was considered significant for all analyses.
Results:
During a 75-month period, a total of 398 procedures were performed for the removal of vaginally placed mesh. A total of 326 (82%) patients underwent single-compartment surgery, 48 (12%) underwent multicompartment surgery, and in 26 (6%), the type of surgery was unclear. The indications for mesh removal included: pain (63%), dyspareunia (57%), mesh exposure (54%), and voiding dysfunction (39%). The mean length of mesh removed was 4 cm (standard deviation±2.8). Those with multicompartment surgery had approximately three times higher estimated blood loss compared with single-compartment surgery (P<.001). The odds of blood transfusion after multicompartment surgery were more than nine times higher than the odds of transfusion after a single-compartment surgery (odds ratio 9.7, 95% confidence interval 2.1-44.6; P<.01).
Conclusion:
Bleeding complications are higher with concomitant removal of mesh from multiple vaginal compartments.
Level Of Evidence:
III.
Insights
Removing vaginal mesh from multiple compartments increases bleeding complications. Multicompartment mesh removal is associated with significantly higher blood loss and transfusion rates compared to single-compartment procedures.
Area of Science:
- Urogynecology
- Pelvic Reconstructive Surgery
- Surgical Complications
Background:
- Vaginal mesh placement is used for pelvic organ prolapse and stress urinary incontinence.
- Mesh removal is increasingly performed due to complications like pain, dyspareunia, and exposure.
- Tertiary care centers manage a high volume of complex mesh removal cases.
Purpose of the Study:
- To evaluate perioperative complications of operating room mesh removal.
- To compare morbidity between single-compartment and multiple-compartment vaginal mesh removal.
Main Methods:
- Retrospective review of 398 vaginal mesh removal procedures (2008-2014).
- Patients categorized by single-compartment vs. multicompartment removal.
- Complications, including blood loss and transfusion rates, were compared.
Main Results:
- Multicompartment mesh removal (12%) had ~3x higher estimated blood loss (P<.001).
- Odds of blood transfusion were >9x higher after multicompartment removal (OR 9.7, P<.01).
- Indications included pain, dyspareunia, mesh exposure, and voiding dysfunction.
Conclusions:
- Concomitant removal of mesh from multiple vaginal compartments is associated with increased bleeding complications.
- Surgical approach impacts perioperative morbidity in vaginal mesh removal.
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