Complications requiring reoperation following vaginal mesh kit procedures for prolapse

doi:10.1016/j.ajog.2008.07.049

American Journal of Obstetrics and Gynecology

Volume 199, Issue 6, December 2008, Pages 678.e1-678.e4

Presented at the 34th Annual Scientific Meeting of the Society of Gynecologic Surgeons, Savannah, GA, April 14-16, 2008.

https://doi.org/10.1016/j.ajog.2008.07.049 Get rights and content

Objective

The objective of the study was to the characterize the symptoms and management of vaginal mesh-related complications requiring operative intervention.

Study Design

This was a case series of patients undergoing excision of vaginal graft material. Only women who had vaginal mesh placement for the correction of pelvic organ prolapse (POP) were included. We describe the symptoms, complications, and management of women treated surgically for vaginal mesh-related complications.

Results

Thirteen referred women underwent surgery for vaginal mesh-related complications. All meshes were Apogee and/or Perigee. Ten had symptomatic mesh exposures, 1 had an exposure with pelvic abscess, and 2 had pain syndromes without mesh exposure. Patients also had rectovaginal fistula, vesicovaginal fistula, recurrent POP, and persistent discharge. Five women had prior surgery for this problem. All patients underwent transvaginal mesh excision and other indicated procedures at our institution, and 6 women required a second surgery at our institution, with a median of 2 surgeries per patient.

Conclusion

Vaginal mesh placement for POP can be associated with pain, exposure, and fistula formation, requiring multiple operative interventions.

Section snippets

Materials and Methods

Surgical billing records of all reconstructive pelvic surgeons (4 urogynecologists, 1 urologist) at the University of Michigan were queried for the excision of any vaginal graft material from 1997 to 2007. The following International Classification of Diseases, 9th revision, codes were used in the search: 57295, revision (including removal) of prosthetic vaginal graft, vaginal approach; 57415, removal of impacted vaginal foreign body (separate procedure) under anesthesia; and 57287, removal or

Results

We identified 13 women who had undergone a removal, excision, or transection of a vaginal mesh that had been placed to treat pelvic organ prolapse. Although we queried billing records from the past 10 years, all cases in this series were performed between August 2005 and November 2007. All 13 women were referred from outside institutions at which their original vaginal mesh surgery had been performed.

All meshes were from the Apogee and/or Perigee system (American Medical Systems, Minnetonka,

Comment

We present a series of 13 women treated at our institution with complications following vaginal mesh surgery for prolapse. All 13 women's prostheses were from the Apogee and/or Perigee repair system. We were unable to determine whether meshes from this system have a higher exposure rate than the other available systems or whether the fact that we saw only Apogee and Perigee complications simply reflects the practice patterns in our referral area.

We found that the majority of these patients had

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Cited by (121)

Letter to the editor
2022, Journal of the Mechanical Behavior of Biomedical Materials
Pelvic and perineal pain after genital prolapse: A literature review
2020, Progres en Urologie
Les douleurs pelvi-périnéales postchirurgie du prolapsus génital sont des complications postopératoires graves et fréquentes dont le diagnostic et le traitement peuvent être complexes.
Nous avons réalisé une revue de la littérature sur la base de données Pubmed en utilisant les mots et MeSH suivants : genital prolapse, pain, dyspareunia, genital prolapse and pain, genital prolapse and dyspareunia, genital prolapse and surgery, pain and surgery.
Parmi les 133 articles trouvés, 74 ont été retenus. Les douleurs pelvi-périnéales chroniques évoluent depuis plus de 3 mois selon l’International Association for the Study of Pain, et peuvent être de type nociceptif, neuropathique ou dysfonctionnel. Leur définition est avant tout clinique. Leur incidence varie de 1 à 50 % et les facteurs de risques suspectés sont un âge jeune, des comorbidités, un antécédent de chirurgie de prolapsus, un stade élevé de prolapsus, des douleurs préopératoires, une voie d’abord chirurgicale invasive, la pose simultanée de plusieurs prothèses, une moindre expérience de l’opérateur, une durée importante d’intervention et des douleurs postopératoires précoces. La voie vaginale peut favoriser une modification de la compliance ou de la longueur vaginale, des lésions des nerfs pudendaux, sciatiques ou obturateurs ou un syndrome myofascial pelviens ; la voie cœlioscopique est à risque de lésion des nerfs pariétaux ; la chirurgie prothétique implique des complications liées aux modifications de prothèse. La prise en charge thérapeutique est complexe et doit être multimodale et pluridisciplinaire.
Les connaissances sur les douleurs pelvi-périnéales après chirurgie du prolapsus génital sont encore limitées à ce jour.
Pelvic and perineal pain after genital prolapse surgery is a serious and frequent post-operative complication which diagnosis and therapeutic management can be complex.
A literature review was carried out on the Pubmed database using the following words and MeSH : genital prolapse, pain, dyspareunia, genital prolapse and pain, genital prolapse and dyspareunia, genital prolapse and surgery, pain and surgery.
Among the 133 articles found, 74 were selected. Post-operative chronic pelvic pain persisting more than 3 months after surgery according to the International Association for the Study of Pain. It can be nociceptive, neuropathic or dysfunctional. Its diagnosis is mainly clinical. Its incidence is estimated between 1% and 50% and the risk factors are young age, the presence of comorbidities, history of prolapse surgery, severe prolapse, preoperative pain, invasive surgical approach, simultaneous placement of several meshes, less operator experience, increased operative time and early post-operative pain. The vaginal approach can cause a change in compliance and vaginal length as well as injury to the pudendal, sciatic and obturator nerves and in some cases lead to myofascial pelvic pain syndrome, whereas the laparoscopic approach can lead to parietal nerve damage. Therapeutic management is multidisciplinary and complex.
Pelvic pain after genital prolapse surgery is still obscure to this day.
Vaginal posterior isthmic sling: A report of 53 cases
2020, Journal of Gynecology Obstetrics and Human Reproduction
Sacrospinofixation is used for fundic vaginal vault’s prolapse or to prevent mid-level or posterior prolapse. It can lead to complications such as dyspareunia, chronic pain, and quality of life impairment. Anchoring a posterior isthmic sling to the two sacrospinous ligaments is an alternative to classic Richter’s sacrospinofixation. Objective of this study is to report the first cases of vaginal posterior isthmic slings.
This study is retrospective and unicentric. It includes women who had posterior isthmic sling at the time of a surgery with a mesh for anterior prolapse by vaginal way between 2010 and 2016 in the gynecologic department of a teaching hospital. Report of efficacy and tolerance was performed.
Between 2010 and 2016, 53 women were included with a posterior isthmic sling and a mesh for an anterior prolapse. POP-Q evolution during the follow-up in the posterior isthmic sling group assess of a good efficacy of the sling. Four women (7.5%) required second surgery in 28 months following initial surgery (only 1 for excision). Four women (7.5%) had a prolapse recurrence in a mean time of 30 months without recurrent surgery. Women’s satisfaction level was high (8.0/10 [7,1–8,8]).
Efficacy and tolerance of the posterior isthmic sling seems good. It might then be an option for mid-level prolapses in case of vaginal surgery with mesh for anterior prolapse. A non-inferiority trial should be performed to be able to conclude on the place of this alternative to Richter’s sacrospinofixation.
Anchorless implant for the treatment of advanced anterior and apical vaginal prolapse – Medium term follow up
2020, European Journal of Obstetrics and Gynecology and Reproductive Biology
Citation Excerpt :
Mesh fixation has been mentioned as a crucial parameter in the development of mesh-related chronic vaginal pain. Resection of the fixation points has been shown to result in reduction of the tension and pain resolution in 90 % of patients [19,21]. We anticipated the anchorless technique would reduce post-operative complications as well, as the solid frame keeps the mesh stretched so that bunching, crimping, mesh contraction and excessive tensioning of mesh arms are avoided.
to evaluate the mid-term safety and efficacy of a surgical technique using an anchorless implant.
This is a prospective study. Women with symptomatic POP were recruited. The technique involved placement of an open trapezoid-shaped frame which retains a polypropylene mesh stretched within its parameter. No fixation techniques used. Demographic data and pre-operative quality of life (QoL) questionnaires were collected. Peri-operative data were documented. Patients were followed at 2, 6, 12, 24 and 36 months. Follow-up included repeated QoL questionnaires, Pelvic Organ Prolapse- Quantification (POP-Q) measurements and assessment for possible complications.
Seventy women were recruited. Mean age was 63.1 years, mean parity was 4.6 deliveries. Mean pre-operative POP-Q were Ba = 3.1 (-1 to 6) cm and C = 0.4 (-8 to 6) cm. No intra-operative complications were observed. Surgical time averaged 24.7 min. Estimated blood loss averaged 155 cc. Mean follow up at last visit was 27.7 months. Two patients (2.8 %) underwent partial frame resection and two patients (2.8 %) underwent a TVT-O for de-novo stress urinary incontinence (SUI). At follow-up, the mean POP-Q were Ba= -2.8 (-3 to -1) cm and C = -6.8 (-10 to 1) cm. Two patients (2.8 %) had recurrent prolapse. One was symptomatic and received treatment. No mesh erosion or chronic pelvic pain were documented. Pelvic Function Distress Inventory (PFDI20) scores showed significant improvement. Thirty-eight (54 %) patients completed the Pelvic organ prolapse/Urinary Incontinence Sexual Questionnaire (PISQ12) showing no chronic dyspareunia.
The Self Retaining Support (SRS) implant provides 97 % subjective and 94.3 % objective cure. Two patients (2.8 %) had the implant’s frame removed surgically. The SRS is a safe and effective treatment for pelvic organ prolapse.
European Urogynaecological Association Position Statement: Pelvic Organ Prolapse Surgery
2023, Urogynecology
A systematic review of the surgical management of apical pelvic organ prolapse
2023, International Urogynecology Journal

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: Cite this article as: Margulies RU, Lewicky-Gaupp C, Fenner DE, et al. Complications requiring reoperation following vaginal mesh kit procedures for prolapse. Am J Obstet Gynecol 2008;199:678.e1-678.e4.

: Reprints not available from the authors.

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Meeting paperSGS paperComplications requiring reoperation following vaginal mesh kit procedures for prolapse

Objective

Study Design

Results

Conclusion

Section snippets

Materials and Methods

Results

Comment

Am J Obstet Gynecol

Obstet Gynecol

Am J Obstet Gynecol

Abdominal sacrocolpopexy: a comprehensive review

Obstet Gynecol

Mechanical properties of synthetic implants used in the repair of prolapse and urinary incontinence in women: which is the ideal material?

Int Urogynecol J Pelvic Floor Dysfunct

Meeting paper
SGS paper
Complications requiring reoperation following vaginal mesh kit procedures for prolapse