Rectal injury during laparoscopic mesh removal after sacrocervicopexy
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IUJ VIDEO
Rectal injury during laparoscopic mesh removal after sacrocervicopexy Ohad Gluck 1 & Ehud Grinstein 1 & Mija Blaganje 2 & Nikolaus Veit-Rubin 3 & Bruno Deval 1 Received: 11 July 2019 / Accepted: 25 October 2019 # The International Urogynecological Association 2019
Abstract In this video we present a case of rectal injury, which occurred during laparoscopic mesh removal following sacrocervicopexy. Four years after sub-total hysterectomy with laparoscopic sacrocervicopexy, a 64-year-old patient still suffered from intense proctalgia and pain while sitting. On physical examination, intense pain could be triggered by palpating the left aspect of the levator ani muscle, raising the suspicion of an association with the mesh and leading to the decision for its removal. The left posterior arm of the mesh was removed completely laparoscopically. During this procedure, a rectal lesion was diagnosed and immediately repaired by a double layer of interrupted sutures. There was an immediate and complete resolution of the symptoms after surgery, with no short-term prolapse recurrence or postoperative complications. Laparoscopy appears to be an efficient approach to mesh excision. A high level of alertness to recognize intraoperative injuries is warranted. Keywords Laparoscopy . Sacrocervicopexy . Mesh removal . Complications
Introduction Sacrocolpopexy is considered to be the treatment of choice for post-hysterectomy vaginal vault prolapse [1]. Success rates between 74 and 98% have been reported, with lower rates of recurrent prolapse (2.3–4% vs. 4.3–18%) and dyspareunia (4– 9% vs. 10–50%) compared with native tissue repair or vaginal mesh procedures [1, 2]. Sacrocolpopexy is associated with higher satisfaction rates and a lower re-operation rate than vaginal sacrospinous fixation [1]. The laparoscopic approach can reduce hospital stay and blood loss [3]. Defecation Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00192-019-04168-5) 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’. * Bruno Deval [email protected] 1
Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, 9 rue Quatrefages, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, 75005 Paris, France
2
Department of Gynecology, University Medical Center, Ljubljana, Slovenia
3
Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
problems and de novo stress urinary incontinence ranging from 17–37% and 4–50%, respectively, are the most frequently reported complications associated with sacrocolpopexy [4]. However, there are concerns about mesh-specific complications, which occur in 0–10.5% of the cases, including mesh exposure, infection, and pain [5, 6]. Cases of mesh removal after sacrocolpopexy/sacrocervicopexy are scarcely described in the literature. In this video we present
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