Abstract: PD17-07
Sources of Funding: none

Introduction

Sacrocolpopexy (SC) using synthetic mesh is considered by many to be the gold standard for apical pelvic organ prolapse repair. Although uncommon, this procedure is not without risk of mesh-related complications. We sought to review our experience with patients suffering from complications of SC mesh placement including pain and mesh exposure necessitating complete mesh removal. We also describe our technique for simultaneous reconstruction with autologous rectus fascia.

Methods

Patients undergoing complete SC mesh removal for mesh-related complications at our institution from March 2013 to September 2016 were identified. Complete mesh removal was defined as excision of SC mesh in its entirety from the sacral promontory to the vaginal cuff or cervix if present, including partial vaginectomy and/or trachelectomy when necessary to completely remove the mesh. After complete mesh removal all patients underwent concomitant SC using autologous rectus fascia to mitigate against recurrent prolapse. A strip of rectus fascia 10cm in length was harvested at the margin of the incision and fashioned into an L shape. The horizontal segment of the L was fixed to the reconstructed vaginal apex and the vertical segment was fixed to the sacral promontory. The electronic medical record was retrospectively reviewed to identify patient demographics, perioperative characteristics, complications within 60 days, and short term surgical outcomes. Complications were graded using the Clavien system and those with a grade ? 3 were classified as major complications.

Results

Nineteen patients were identified. Median patient age was 56 years old (range 35-78). Median time from mesh placement to removal was 4.5 years (range 0-13 years). Indications include pelvic pain which was present in all patients in this series and mesh exposure in 8 patients (42%). Median operative time was 228 minutes (range 133-362). Median estimated blood loss was 200ml (range 50-1000ml). Median length of stay was 5 days (range 2-9). The rate of minor and major complications within 60 days was 36.8% and 5.3% respectively. One patient had a delayed presentation of ureteral obstruction managed with ureterolysis. There were no cases of bladder or bowel injury. At a median follow up of 296 days no patients required secondary surgery for vault prolapse.

Conclusions

Autologous rectus fascia SC at the time of complete removal of synthetic SC mesh can be accomplished safely with a low rate of major complications. These are short term findings and longer term follow up is needed to assess anatomic and functional outcomes.

Funding

none