Mesh Erosion After Abdominal Sacrocolpopexy

Abstract

In Brief Objective To report our experience with erosion of perma-nent suture or mesh material after abdominal sacrocol-popexy. Methods A retrospective chart review was performed to identify patients who underwent sacrocolpopexy by the same surgeon over 8 years. Demographic data, operative notes, hospital records, and office charts were reviewed after sacrocolpopexy. Patients with erosion of either suture or mesh were treated initially with conservative therapy fol-lowed by surgical intervention as required. Results Fifty-seven patients underwent sacrocolpopexy using synthetic mesh during the study period. The mean (range) postoperative follow-up was 19.9 (1.3–50) months. Seven patients (12%) had erosions after abdominal sacrocol-popexy with two suture erosions and five mesh erosions. Patients with suture erosion were asymptomatic compared with patients with mesh erosion, who presented with vagi-nal bleeding or discharge. The mean (6 66 standard deviation) time to erosion was 14.0 6 66 7.7 (range 4–24) months. Both patients with suture erosion were treated conservatively with estrogen cream. All five patients with mesh erosion required transvaginal removal of the mesh. Conclusion Mesh erosion can follow abdominal sacrocol-popexy over a long time, and usually presents as vaginal bleeding or discharge. Although patients with suture ero-sion can be managed successfully with conservative treat-ment, patients with mesh erosion require surgical interven-tion. Transvaginal removal of the mesh with vaginal advancement appears to be an effective treatment in patients failing conservative management. Synthetic mesh erosion, a recognized complication of abdominal sacrocolpopexy, is treated effectively with transvaginal excision of the mesh and vaginal advancement.