Surgical removal of sacrocolpopexy mesh due to chronic inflammatory reaction
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IMAGES IN UROGYNECOLOGY
Surgical removal of sacrocolpopexy mesh due to chronic inflammatory reaction Jacqueline Y. Kikuchi 1
&
Stephanie L. Wethington 1 & Danielle Patterson 1
Received: 12 May 2020 / Accepted: 17 July 2020 # The International Urogynecological Association 2020
Keywords Inflammatory reaction . Mesh complication . Mesh rejection . Mesh removal . Sacrocolpopexy
Introduction Sacrocolpopexy is the gold standard for apical vaginal prolapse repair, but carries the risk of mesh complications. Postoperative infections have been well described in the literature; however, there are very few reports describing inflammatory reactions to sacrocolpopexy mesh, especially for several years following surgery [1, 2]. We present a rare case of a sacrocolpopexy mesh reaction with chronic inflammation.
post-operative day 7, a 3-cm superficial defect with no visible mesh was visualized at the right vaginal apex, and computed tomography (CT) revealed a 12-cm fluid collection extending from the vaginal apex to the sacral promontory (Figs. 1, 2). She was afebrile without leukocytosis (WBC 12,000) and received intravenous antibiotics for a presumed abscess. Two days later, her discharge remained unchanged, and a repeat examination revealed significant sloughing of the vaginal epithelium
Case study A 62-year-old woman presented to our clinic with a 5year history of persistent vaginal discharge following a post-hysterectomy robotic-assisted sacrocolpopexy with type 1 polypropylene mesh. She had previously undergone a total hysterectomy. She subsequently underwent two vaginal sinus tract excisions at the outside institution without symptomatic improvement. On initial presentation to our clinic, a possible small area of mesh exposure was palpated at the right vaginal apex. The exposure resolved with vaginal estrogen therapy, but her discharge remained unchanged. We then performed an uncomplicated vaginoscopy and sinus tract excision at the right apex. Mesh was not visualized or encountered during this excision, which measured less than 1 cm, and the tract was closed in multiple layers using polyglactin 910 suture. Post-operatively, her discharge worsened acutely. On * Jacqueline Y. Kikuchi [email protected] 1
Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, 4940 Eastern Ave, Baltimore, MD 21224, USA
Fig. 1 A sagittal view of the patient’s CT abdomen and pelvis was notable for an elongated, midline fluid collection (green arrow) measuring 12 by 7 by 2 cm extending from the vaginal apex to the sacral promontory
Int Urogynecol J
Fig. 2 A coronal view of the patient’s CT abdomen and pelvis revealing the elongated fluid collection (green arrow)
Fig. 4 Owing to concern regarding a worsening infection of the sacrocolpopexy mesh, the patient underwent exploratory laparotomy for mesh removal. Intraoperatively, the mesh was not scarred into any surrounding tissue and was not attached to the vagina. It was freely mobile within a fibrotic capsule and was easily removed in its entirety. The g
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