Abstract
Abstract
Introduction and hypothesis
The objective was to present endoscopic images of a meshoma and describe the complete excision of a complicated mesh after sacrocolpopexy (SCP) using a combined vaginal-endoscopic technique.
Methods
We present a video documentation of an innovative technique. A 58-year-old woman was referred with painless, foul-smelling vaginal discharge and recurrent vaginal mesh erosions. She had undergone a laparoscopic SCP 12 years ago and her symptoms had begun 5 years ago. A pre-operative MRI scan revealed a cuff meshoma and an inflammatory sinus around the mesh extending from the cuff to the sacral promontory. Under general anesthesia, a 30° hysteroscope was inserted transvaginally into the sinus, where the retained mesh was seen in the form of a shrunken meshoma, and then the mesh arms were recognized extending cephalad into a sinus tract. Under direct endoscopic visualization, the mesh was carefully mobilized at its highest point with the use of laparoscopic grasping forceps. Then, the mesh was dissected with hysteroscopic scissors in close proximity to the bone. No peri-operative complications were recognized.
Results
A combined vaginal-endoscopic approach was successfully used to remove an eroded mesh and cuff meshoma after SCP.
Conclusion
This procedure offers a minimally invasive, low-morbidity, and rapid-recovery approach.
Funder
Aristotle University of Thessaloniki
Publisher
Springer Science and Business Media LLC
Subject
Urology,Obstetrics and Gynecology
Reference10 articles.
1. Abrams P, Andersson K-E, Apostolidis A, et al. 6th International consultation on incontinence. Recommendations of the international scientific committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence. Neurourol Urodyn. 2018;37(7):2271–2.
2. Toozs-Hobson P, Boos K, Cardozo L. Management of vaginal vault prolapse. Br J Obstet Gynaecol. 1998;105:13–7.
3. Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev. 2016; 10:CD012376.
4. Romero A, Amundsen C, Weidner A, Webster G. Transvaginal endoscopic removal of eroded mesh after abdominal sacral colpopexy. Obstet Gynecol. 2004;103(5 Pt 2):1040–2.
5. Weidner AC, Cundiff GW, Harris RL, Addison WA. Sacral osteomyelitis: an unusual complication of abdominal sacral colpopexy. Obstet Gynecol. 1997;90:689–91.