Int Urogynecol J DOI 10.1007/s00192-015-2683-z
IUJ VIDEO
Rectal perforation at the time of vaginal mesh placement and subsequent abdominal mesh removal Patrick Lang 1 & Sallie Oliphant 1 & Jason Mizell 2 & Becca Austin 1 & Susan Barr 1
Received: 27 October 2014 / Accepted: 11 March 2015 # The International Urogynecological Association 2015
Abstract Introduction We present an uncommon complication of vaginally placed synthetic prolapse mesh and demonstrate repair of rectal mesh perforation. Methods A 41-year-old was referred with multiple complaints following rectocele repair using a posterior vaginal mesh kit 5 months earlier. In the immediate postoperative period, she experienced severe pain radiating down her right leg, pelvic pain, dyspareunia, dyschezia, diarrhea, and new onset fecal incontinence. Our examination revealed tight, tender mesh arms palpable at the vaginal apex with no evidence of erosion or rectovaginal fistula. Rectal examination revealed intrarectal mesh traversing the rectal lumen 6 cm from the anal verge. Pelvic MRI demonstrated a possible rectovaginal fistula with inflammation surrounding the right sciatic nerve plexus. The patient underwent exploratory laparotomy, removal of the mesh, primary repair of two perforating rectal defects and diverting loop ileostomy. Postoperatively she experienced immediate improvement in pain and later underwent successful take-down of her ileostomy. She did well with improvement of bowel function, continence of feces, improvement of pain, and no recurrence of prolapse.
Electronic supplementary material The online version of this article (doi:10.1007/s00192-015-2683-z) contains supplementary material. This video is also available to watch on http://videos.springer.com/;. Please search for the video by the article title. * Patrick Lang [email protected] 1
Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
2
Department of Colorectal surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Conclusion Our video shows an abdominal approach for mesh removal and repair of rectal mesh injury occurring from vaginal mesh placement. We discuss the rationale for the abdominal approach and review techniques for proper placement of posterior vaginal mesh. Keywords Posterior vaginal mesh . Mesh complication . Rectal injury Vaginal mesh has been used in the repair of pelvic organ prolapse since the 1970s. The most recent US data shows that over 300,000 women per year undergo surgical procedures to repair pelvic organ prolapse and one in three of those procedures utilize synthetic mesh augmentation. As of 2010, the Manufacturer and User Facility Device Experience Database (MAUDE) revealed 3,979 adverse events associated with mesh products used during urogynecologic surgery. The most common reported adverse event was mesh erosion with a risk of 10 – 30 % [1]. Other risks include perioperative damage to the bladder and bowel during dissection that occurs in
IUJ VIDEO
Rectal perforation at the time of vaginal mesh placement and subsequent abdominal mesh removal Patrick Lang 1 & Sallie Oliphant 1 & Jason Mizell 2 & Becca Austin 1 & Susan Barr 1
Received: 27 October 2014 / Accepted: 11 March 2015 # The International Urogynecological Association 2015
Abstract Introduction We present an uncommon complication of vaginally placed synthetic prolapse mesh and demonstrate repair of rectal mesh perforation. Methods A 41-year-old was referred with multiple complaints following rectocele repair using a posterior vaginal mesh kit 5 months earlier. In the immediate postoperative period, she experienced severe pain radiating down her right leg, pelvic pain, dyspareunia, dyschezia, diarrhea, and new onset fecal incontinence. Our examination revealed tight, tender mesh arms palpable at the vaginal apex with no evidence of erosion or rectovaginal fistula. Rectal examination revealed intrarectal mesh traversing the rectal lumen 6 cm from the anal verge. Pelvic MRI demonstrated a possible rectovaginal fistula with inflammation surrounding the right sciatic nerve plexus. The patient underwent exploratory laparotomy, removal of the mesh, primary repair of two perforating rectal defects and diverting loop ileostomy. Postoperatively she experienced immediate improvement in pain and later underwent successful take-down of her ileostomy. She did well with improvement of bowel function, continence of feces, improvement of pain, and no recurrence of prolapse.
Electronic supplementary material The online version of this article (doi:10.1007/s00192-015-2683-z) contains supplementary material. This video is also available to watch on http://videos.springer.com/;. Please search for the video by the article title. * Patrick Lang [email protected] 1
Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
2
Department of Colorectal surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Conclusion Our video shows an abdominal approach for mesh removal and repair of rectal mesh injury occurring from vaginal mesh placement. We discuss the rationale for the abdominal approach and review techniques for proper placement of posterior vaginal mesh. Keywords Posterior vaginal mesh . Mesh complication . Rectal injury Vaginal mesh has been used in the repair of pelvic organ prolapse since the 1970s. The most recent US data shows that over 300,000 women per year undergo surgical procedures to repair pelvic organ prolapse and one in three of those procedures utilize synthetic mesh augmentation. As of 2010, the Manufacturer and User Facility Device Experience Database (MAUDE) revealed 3,979 adverse events associated with mesh products used during urogynecologic surgery. The most common reported adverse event was mesh erosion with a risk of 10 – 30 % [1]. Other risks include perioperative damage to the bladder and bowel during dissection that occurs in
