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Mesh erosion after abdominal sacrocolpopexy
1Division of Urogynecology and Reconstructive Pelvic Surgery, Good Samaritan Hospital, University of Cincinnati School of Medicine, Ohio 45220, USA. neerajk@aol.com
Objective:
To report our experience with erosion of permanent suture or mesh material after abdominal sacrocolpopexy.
Methods:
A retrospective chart review was performed to identify patients who underwent sacrocolpopexy by the same surgeon over 8 years. Demographic data, operative notes, hospital records, and office charts were reviewed after sacrocolpopexy. Patients with erosion of either suture or mesh were treated initially with conservative therapy followed by surgical intervention as required.
Results:
Fifty-seven patients underwent sacrocolpopexy using synthetic mesh during the study period. The mean (range) postoperative follow-up was 19.9 (1.3-50) months. Seven patients (12%) had erosions after abdominal sacrocolpopexy with two suture erosions and five mesh erosions. Patients with suture erosion were asymptomatic compared with patients with mesh erosion, who presented with vaginal bleeding or discharge. The mean (+/-standard deviation) time to erosion was 14.0+/-7.7 (range 4-24) months. Both patients with suture erosion were treated conservatively with estrogen cream. All five patients with mesh erosion required transvaginal removal of the mesh.
Conclusion:
Mesh erosion can follow abdominal sacrocolpopexy over a long time, and usually presents as vaginal bleeding or discharge. Although patients with suture erosion can be managed successfully with conservative treatment, patients with mesh erosion require surgical intervention. Transvaginal removal of the mesh with vaginal advancement appears to be an effective treatment in patients failing conservative management.
Insights
Suture erosion after abdominal sacrocolpopexy is rare and manageable with conservative treatment. Mesh erosion, however, requires surgical intervention, often transvaginal removal, due to persistent symptoms like bleeding or discharge.
Area of Science:
- Urogynecology
- Pelvic reconstructive surgery
Background:
- Abdominal sacrocolpopexy is a surgical procedure for pelvic organ prolapse.
- Complications such as suture or mesh erosion can occur post-operatively.
Purpose of the Study:
- To evaluate the incidence and management of suture and mesh erosion following abdominal sacrocolpopexy.
Main Methods:
- Retrospective chart review of patients undergoing sacrocolpopexy over 8 years.
- Analysis of demographic data, operative details, and patient outcomes.
- Review of treatment strategies for suture and mesh erosion.
Main Results:
- Seven out of 57 patients (12%) experienced erosion (2 suture, 5 mesh).
- Mesh erosion presented with vaginal bleeding/discharge, while suture erosion was asymptomatic.
- Suture erosion managed conservatively; mesh erosion required transvaginal mesh removal.
Conclusions:
- Mesh erosion is a potential long-term complication of abdominal sacrocolpopexy, often presenting with vaginal bleeding or discharge.
- Conservative management is effective for suture erosion.
- Transvaginal mesh removal is an effective treatment for mesh erosion unresponsive to conservative measures.