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Analysis of Complications of Pelvic Mesh Excision Surgery Using the Clavien-Dindo Classification System
Goran Rac1, Alyssa Greiman1, Andrew Rabley1
1Department of Urology, Medical University of South Carolina, Charleston, South Carolina; Urology of Kaiser Permanente Medical Center (MK), San Diego, California.
Purpose:
We describe and categorize complications using the Clavien-Dindo classification system in patients who underwent vaginal mesh excision surgery.
Materials And Methods:
With institutional review board approval we retrospectively reviewed the records of 277 patients who underwent vaginal mesh extraction between 2007 and 2015 at a single institution. Surgical complications were stratified using the Clavien-Dindo classification system. Complications were perioperative (prior to discharge) or postoperative (within 90 days). Indications for initial mesh placement, mesh revision procedure, time to resolution and medical comorbidities were assessed.
Results:
Of the 277 patients 47.3% had at least 1 surgical complication, including multiple complications in 7.2%. A total of 155 complications were identified, which were grade II in 49.0% of cases, grade I in 25.8%, grade IIIb in 18.7%, grade IIIa in 5.2% and grade IVa in 1.3%. No grade IVb or V complications were identified. The indication for initial mesh placement did not significantly affect complication frequency. Patients who underwent combined stress urinary incontinence and pelvic organ prolapse mesh revision surgeries had an increased frequency of complications compared to those treated with mesh revision surgery for pelvic organ prolapse or stress urinary incontinence alone (p = 0.045). Most complications occurred postoperatively and resolved by 90 days. Age, body mass index, smoking status and diabetes were not associated with increased complications.
Conclusions:
Despite the complexity of mesh revision surgery most complications are minor. Serious complications may develop, emphasizing the need for proper patient counseling and surgical experience when performing these procedures.
Insights
Vaginal mesh excision surgery has a 47.3% complication rate, with most being minor. Careful patient selection and experienced surgeons are crucial for managing these procedures.
Area of Science:
- Urogynecology
- Surgical Complications
- Medical Device Safety
Background:
- Vaginal mesh use for pelvic floor disorders has led to complications requiring surgical intervention.
- The Clavien-Dindo classification system provides a standardized method for grading surgical complications.
Purpose of the Study:
- To categorize and describe surgical complications following vaginal mesh excision.
- To evaluate factors influencing complication rates in patients undergoing mesh removal.
Main Methods:
- Retrospective review of 277 patients undergoing vaginal mesh extraction (2007-2015).
- Complications were classified using the Clavien-Dindo system.
- Analysis included indications for mesh placement, revision type, and patient comorbidities.
Main Results:
- 47.3% of patients experienced at least one complication; 7.2% had multiple.
- Most common complications were Grade II (49.0%) and Grade I (25.8%).
- Combined stress urinary incontinence and pelvic organ prolapse mesh revision was associated with higher complication rates (p=0.045).
Conclusions:
- Despite the complexity of mesh revision, most complications are minor.
- Serious complications can occur, highlighting the importance of patient counseling and surgical expertise.
