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Laparoscopic Colposacropexy Mesh Excision Secondary to Severe Spondylodiscitis
A Luzarraga Aznar1, I Mora Hervas1, E Magret Descamps1
1Department of XXX, Hospital de la Santa Creu i de Sant Pau, Barcelona, Spain (all authors).
Study Objective:
To describe laparoscopic mesh excision for severe spondylodiscitis secondary to colposacropexy mesh infection and demonstrate its feasibility.
Design:
Step-by-step description of the surgical procedure using an educational video.
Setting:
Spondylodiscitis is an uncommon and severe complication after sacrocolpopexy [1], with only 34 cases published to date [2]. Symptoms usually appear weeks after surgery, the most common being back pain irradiating toward the lower extremities and fever [3,4]. Treatment consists of intravenous antibiotic therapy for a minimum of 6 weeks, and approximately 70% require a surgical treatment [2] including mesh removal and debridement of the necrotic material [5].
Interventions:
A 55-year-old woman received an intervention for colposacropexy 2 months before owing to severe hysterocele and cystocele and consulted for fever and intense lumbar pain. She was diagnosed as having L5 to S1 spondylodiscitis secondary to colposacropexy mesh infection. She received endovenous antibiotic treatment for 6 weeks and underwent a laparoscopic mesh excision to facilitate resolution of infection. Laparoscopic approach with a standard 4-port placement configuration was used, enabling the identification of the colposacropexy mesh. Surgical strategy initially consisted of dissection of the promontory, vesicovaginal, and pararectal spaces, having previously identified the main anatomic landmarks to preserve them. Suspension of the promontory peritoneum and the bladder to the abdominal wall enabled a better exposure of the surgical field, facilitating the dissection and excision of the mesh. Postoperative course was uneventful, and the patient was discharged 4 days later.
Conclusion:
Owing to minimal morbidity and good results, laparoscopic mesh excision should be considered an effective treatment for spondylodiscitis secondary to mesh infection.
Insights
Laparoscopic mesh excision is a feasible treatment for severe spondylodiscitis caused by colposacropexy mesh infection. This minimally invasive approach offers good results and minimal morbidity for patients.
Area of Science:
- Minimally invasive surgery
- Gynecologic surgery
- Infectious disease
Background:
- Spondylodiscitis is a rare but severe complication following sacrocolpopexy.
- Symptoms include back pain and fever, often appearing weeks post-surgery.
- Surgical intervention, including mesh removal, is required in about 70% of cases.
Observation:
- A case study of a 55-year-old woman with L5-S1 spondylodiscitis secondary to mesh infection after colposacropexy.
- The patient underwent a 6-week course of intravenous antibiotics.
- A laparoscopic mesh excision was performed using a standard 4-port configuration.
Findings:
- The laparoscopic approach allowed for identification and successful excision of the infected mesh.
- Key anatomical spaces were dissected while preserving vital structures.
- The patient experienced an uneventful postoperative recovery and was discharged within 4 days.
Implications:
- Laparoscopic mesh excision is an effective treatment option for spondylodiscitis secondary to mesh infection.
- The procedure demonstrates minimal morbidity and positive patient outcomes.
- This technique should be considered for managing similar complex surgical complications.
