Gülşen Doğan Durdağ1, Songül Alemdaroğlu2, Emre Durdağ3, Seda Yüksel Şimşek2, Tuba Turunç4, Selçuk Yetkinel2, Şafak Yılmaz Baran2, Hüsnü Çelik2. 1. Department of Gynecology and Obstetrics, Başkent University Adana Dr. Turgut Noyan Application and Research Hospital, Adana, Turkey. gulsendogan@hotmail.com. 2. Department of Gynecology and Obstetrics, Başkent University Adana Dr. Turgut Noyan Application and Research Hospital, Adana, Turkey. 3. Department of Neurosurgery, Başkent University Adana Dr. Turgut Noyan Application and Research Hospital, Adana, Turkey. 4. Department of Infectious Diseases, Başkent University Adana Dr. Turgut Noyan Application and Research Hospital, Adana, Turkey.
Abstract
INTRODUCTION AND HYPOTHESIS: Sacrocolpopexy is considered to be the gold-standard procedure for apical compartment prolapse. However, complications such as sacral hemorrhage, small bowel obstruction, port site herniation, mesh erosion, mesh exposure, and occasionally discitis may occur. The aim of this study is to show laparoscopic treatment of L5-S1 discitis 3 months following laparoscopic sacrocolpopexy. METHODS: Two surgical interventions of a case with narrated video footage is presented. RESULTS: Laparoscopic sacrocolpopexy following hysterectomy in the first part and re-laparoscopy because of a diagnosis of discitis refractory to medical treatment, and removal of mesh along with anterior L5-S1 discectomy for curative debridement in the second part is demonstrated. CONCLUSION: Frequency of postoperative discitis has been increased by the widespread use of a laparoscopic approach. In order to reduce the complication rate, surgical technique allowing the needle to penetrate only the depth of the anterior longitudinal ligament and usage of monofilament suture for mesh attachment is recommended. In treatment, removal of the sacral mesh, and even extensive tissue debridement, may be necessary.
INTRODUCTION AND HYPOTHESIS: Sacrocolpopexy is considered to be the gold-standard procedure for apical compartment prolapse. However, complications such as sacral hemorrhage, small bowel obstruction, port site herniation, mesh erosion, mesh exposure, and occasionally discitis may occur. The aim of this study is to show laparoscopic treatment of L5-S1 discitis 3 months following laparoscopic sacrocolpopexy. METHODS: Two surgical interventions of a case with narrated video footage is presented. RESULTS: Laparoscopic sacrocolpopexy following hysterectomy in the first part and re-laparoscopy because of a diagnosis of discitis refractory to medical treatment, and removal of mesh along with anterior L5-S1 discectomy for curative debridement in the second part is demonstrated. CONCLUSION: Frequency of postoperative discitis has been increased by the widespread use of a laparoscopic approach. In order to reduce the complication rate, surgical technique allowing the needle to penetrate only the depth of the anterior longitudinal ligament and usage of monofilament suture for mesh attachment is recommended. In treatment, removal of the sacral mesh, and even extensive tissue debridement, may be necessary.