Lumbosacral discitis as a rare complication of laparoscopic sacrocolpopexy
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Lumbosacral discitis as a rare complication of laparoscopic sacrocolpopexy Gülşen Doğan Durdağ 1 & Songül Alemdaroğlu 1 & Emre Durdağ 2 & Seda Yüksel Şimşek 1 & Tuba Turunç 3 & Selçuk Yetkinel 1 & Şafak Yılmaz Baran 1 & Hüsnü Çelik 1 Received: 25 February 2020 / Accepted: 5 May 2020 # The International Urogynecological Association 2020
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. Keywords Complications . Discitis . Laparoscopic . Mesh . Sacrocolpopexy
Introduction
This work was presented as a poster presentation at the American College of Surgeons Turkey Chapter Meeting, Ankara, Turkey, 5–6 September 2019 Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00192-020-04331-3) contains supplementary material. This video is also available to watch on http://link.springer. com/. Please search for this article by the article title or DOI number, and on the article page click on ‘Supplementary Material’ * Gülşen Doğan Durdağ [email protected] 1
Department of Gynecology and Obstetrics, Başkent University Adana Dr. Turgut Noyan Application and Research Hospital, Adana, Turkey
2
Department of Neurosurgery, Başkent University Adana Dr. Turgut Noyan Application and Research Hospital, Adana, Turkey
3
Department of Infectious Diseases, Başkent University Adana Dr. Turgut Noyan Application and Research Hospital, Adana, Turkey
Sacrocolpopexy is considered the gold standard procedure for apical compartment prolapse owing to its superior functional outcomes as well as lower reoperation rates and long-term durability [1]. However, complications associated with sacrocolpopexy are also greater than those of native tissue vaginal repair procedures, and this operation is recommended to be reserved for women with posthysterectomy vaginal vault prolapse and for women with advanced stage uterine prolapse. Sacral hemorrhag
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