OBJECTIVE: Mesh erosion through the vagina is the most common complication of synthetic mesh used for pelvic organ prolapse repair.
However, conventional transvaginal mesh excision has many technical limitations. We aimed at creating and describing a new surgical technique for transvaginal removal of exposed mesh that would enable better exposition and access, thus facilitating optimal treatment.
DESIGN: Step-by-step video demonstrating the technique.
SETTING: University tertiary care hospital.
PATIENTS: Five patients previously submitted to pelvic organ prolapse repair using synthetic mesh, presenting mesh erosion through the vagina.
INTERVENTION: Mesh excision using a laparoscopy-like operative vaginoscopy, in which standard laparoscopic instruments are used through a single-incision laparoscopic surgery port device placed in the vagina.
MEASUREMENTS AND MAIN RESULTS: In all cases, a very good exposure of the mesh was achieved, a minimal tissue traction was required, and the procedures were performed in a very ergonomic way. All the patients were discharged in the same day of the surgery, and had a painless postoperative course. So far there have not been cases of relapse of the complaints.
CONCLUSION: This seems to be a simple, cheap and valuable minimally invasive technique, with many advantages in comparison with the conventional approach. More cases and time are necessary to access its long-term efficacy. It may possibly be used for the management of other conditions.
Written by:
Billone V, Amorim-Costa C, Campos S, Rabischong B, Bourdel N, Canis M, Botchorishvili R. Are you the author?
CHU Clermont-Ferrand, CHU Estaing, Chirurgie Gynécologique, Clermont-Ferrand, France.
Reference: J Minim Invasive Gynecol. 2014 Sep 10. pii: S1553-4650(14)01290-4.
doi: 10.1016/j.jmig.2014.09.004
PubMed Abstract
PMID: 25218994