Margalida Vicens-Vidal1, Marta Ramis2, Ricardo-Abel Lizarbe2, Angel Martin2. 1. Obstetrics & Gynecology, Hospital Universitari Son Llàtzer, Carretera de Manacor Km 4, 07198, Palma de Mallorca, Balearic Islands, Spain. margalidavicens@yahoo.es. 2. Obstetrics & Gynecology, Hospital Universitari Son Llàtzer, Carretera de Manacor Km 4, 07198, Palma de Mallorca, Balearic Islands, Spain.
Abstract
PURPOSE: Sacrocolpopexy is considered the gold-standard procedure for apical compartment prolapse and has become a widely used intervention strategy. The mesh material used in the surgical treatment of pelvic organ prolapse is associated with significant complications in some cases, frequently managed conservatively but sometimes necessitating mesh excision for symptom relief. METHODS: In this video we present the case of a 49-year-old woman who after sacrocolpopexy reported foul-smelling discharge as the only symptom. The patient was treated with vaginocervical seroma debridement and removal of large parts of the mesh and paravaginal tissue. A methodical procedure including retroperitoneal dissection along with identification of the anatomical landmarks is critical in cases of suspected mesh infection and facilitates the procedure. RESULTS: The operation does not include a complete mesh excision in order to avoid major surgery and to reduce the risk of recurrent prolapse. In the follow-up visits at 1 and 6 months postoperatively the patient was asymptomatic. CONCLUSION: Synthetic mesh activates an inflammatory process that leads to surrounding tissue fibrosis and scar tissue formation that can distort the pelvic anatomy (Chamsy and Lee in J Minim Invasive Gynecol. 21(6):986, 2014), thereby making dissection more difficult. This surgical procedure requires a comprehensive knowledge of the pelvic anatomy and a methodical surgical strategy.
PURPOSE: Sacrocolpopexy is considered the gold-standard procedure for apical compartment prolapse and has become a widely used intervention strategy. The mesh material used in the surgical treatment of pelvic organ prolapse is associated with significant complications in some cases, frequently managed conservatively but sometimes necessitating mesh excision for symptom relief. METHODS: In this video we present the case of a 49-year-old woman who after sacrocolpopexy reported foul-smelling discharge as the only symptom. The patient was treated with vaginocervical seroma debridement and removal of large parts of the mesh and paravaginal tissue. A methodical procedure including retroperitoneal dissection along with identification of the anatomical landmarks is critical in cases of suspected mesh infection and facilitates the procedure. RESULTS: The operation does not include a complete mesh excision in order to avoid major surgery and to reduce the risk of recurrent prolapse. In the follow-up visits at 1 and 6 months postoperatively the patient was asymptomatic. CONCLUSION: Synthetic mesh activates an inflammatory process that leads to surrounding tissue fibrosis and scar tissue formation that can distort the pelvic anatomy (Chamsy and Lee in J Minim Invasive Gynecol. 21(6):986, 2014), thereby making dissection more difficult. This surgical procedure requires a comprehensive knowledge of the pelvic anatomy and a methodical surgical strategy.
Entities:
Keywords:
Mesh infection; Pelvic organ prolapse; Sacrocolpopexy; Surgical complication
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