Related Experiment Video
Updated: Oct 2, 2025
Author Spotlight: Advancing Pelvic Prolapse Treatment with a Non-Mesh Approach using Laparoscopic Pectopexy
Published on: October 25, 2024
Mesh exposure following minimally invasive sacrocolpopexy: a narrative review
Stephanie Deblaere1,2, Jan Hauspy3, Karen Hansen3
1Department of Obstetrics and Gynaecology, GZA Hospitals, St. Augustinus Hospital, Wilrijk, Oosterveldlaan 24, 2610, Antwerp, Belgium. stephanie.deblaere@uzgent.be.
Introduction And Hypothesis:
Sacrocolpopexy is considered mainstay treatment for apical or vaginal vault prolapse and is currently most often performed via a minimally invasive approach. Although mesh-related complications after this procedure are uncommon, mesh exposure can have an important impact on the patient's quality of life. Our objective is to perform a literature review on this complication post laparoscopic or robotic sacrocolpopexy.
Methods:
Web of Science and MEDLINE databases were searched for relevant articles published between 2005 and 2021. We retrieved 272 articles of which 83 ultimately were withheld.
Results:
Minimally invasive sacrocolpopexy (MISC) implies a low risk of mesh exposure, which is currently estimated at 3.5%. Literature however is marked by substantial methodological heterogeneity. Controversy remains in the debate over prevention of mesh exposure after MISC. Performing a concomitant total hysterectomy is associated with an increased risk compared to subtotal hysterectomy or hysteropexy. Treatment of mesh exposure is challenging as guidelines are lacking. Although supported by few prospective data, patients with asymptomatic mesh exposure are managed conservatively. Surgical intervention, preferentially performed by an experienced pelvic surgeon, is indicated in symptomatic patients.
Conclusions:
Mesh exposure is often undiagnosed and remains untreated. There is a gap in evidence exploring risk factors for mesh-related complications and efficient measures for reducing them. Choosing the best treatment option is still difficult. Management should be individualized and optimized at the time of diagnosis. Lack of acknowledgement and experience can result in increased morbidity.
Insights
Mesh exposure after minimally invasive sacrocolpopexy (MISC) is uncommon but impacts quality of life. Management is challenging due to a lack of guidelines and evidence, requiring individualized treatment.
Area of Science:
- Urogynecology
- Minimally Invasive Surgery
- Pelvic Reconstructive Surgery
Background:
- Sacrocolpopexy is a primary treatment for apical or vaginal vault prolapse, often performed minimally invasively.
- Mesh-related complications, such as mesh exposure, can significantly affect patient quality of life despite being uncommon.
Purpose of the Study:
- To conduct a literature review on mesh exposure complications following laparoscopic or robotic sacrocolpopexy.
- To explore risk factors, prevention strategies, and management of mesh exposure after minimally invasive sacrocolpopexy (MISC).
Main Methods:
- A comprehensive literature search of Web of Science and MEDLINE databases was performed.
- Articles published between 2005 and 2021 were reviewed, with 83 articles ultimately included from an initial retrieval of 272.
Main Results:
- Minimally invasive sacrocolpopexy (MISC) has a low reported risk of mesh exposure (approximately 3.5%), but studies show significant methodological heterogeneity.
- Concomitant total hysterectomy increases mesh exposure risk compared to subtotal hysterectomy or hysteropexy.
- Treatment guidelines for mesh exposure are lacking; asymptomatic cases are managed conservatively, while symptomatic cases require surgical intervention by experienced surgeons.
Conclusions:
- Mesh exposure after MISC is often undiagnosed and untreated, highlighting a gap in understanding risk factors and effective reduction measures.
- Individualized management is crucial for optimizing outcomes, as a lack of acknowledgement and experience can increase morbidity.
- Further evidence is needed to guide the prevention and treatment of mesh exposure following sacrocolpopexy procedures.
