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Transrectal Mesh Erosion Requiring Bowel Resection.
J Minim Invasive Gynecol. 2017 Jul - Aug; 24(5):717-721.JM

Abstract

STUDY OBJECTIVE

To report a case of a transrectal mesh erosion as complication of laparoscopic promontofixation with mesh repair, necessitating bowel resection and subsequent surgical interventions.

INTRODUCTION

Sacrocolpopexy has become a standard procedure for vaginal vault prolapse [1], and the laparoscopic approach has gained popularity owing to more rapid recovery and less morbidity [2,3]. Mesh erosion is a well-known complication of surgical treatment for prolapse as reported in several negative evaluations, including a report from the US Food and Drug Administration in 2011 [4]. Mesh complications are more common after surgeries via the vaginal approach [5]; nonetheless, the incidence of vaginal mesh erosion after laparoscopic procedures is as high as 9% [6]. The incidence of transrectal mesh exposure after laparoscopic ventral rectopexy is roughly 1% [7]. The diagnosis may be delayed because of its rarity and variable presentation. In addition, polyester meshes, such as the mesh used in this case, carry a higher risk of exposure [8].

CASE REPORT

A 57-year-old woman experiencing genital prolapse, with the cervix classified as +3 according to the Pelvic Organ Prolapse Quantification system, underwent laparoscopic standard sacrocolpopexy using polyester mesh. Subtotal hysterectomy and bilateral adnexectomy were performed concomitantly. A 3-year follow-up consultation demonstrated no signs or symptoms of erosion of any type. At 7 years after the surgery, however, the patient presented with rectal discharge, diagnosed as infectious rectocolitis with the isolation of Clostridium difficile. She underwent a total of 5 repair surgeries in a period of 4 months, including transrectal resection of exposed mesh, laparoscopic ablation of mesh with digestive resection, exploratory laparoscopy with abscess drainage, and exploratory laparoscopy with ablation of residual mesh and transverse colostomy. She recovered well after the last intervention, exhibiting no signs of vaginal or rectal fistula and no recurrence of pelvic floor descent. Her intestinal transit was reestablished, and she was satisfied with the treatment.

CONCLUSION

None of the studies that represent the specific female population submitted to laparoscopic promontofixation with transrectal mesh erosion describe the need for more than one intervention or digestive resection [9-12]. Physicians dealing with patients submitted to pelvic reconstructive surgeries with mesh placement should be aware of transrectal and other nonvaginal erosions of mesh, even being rare events. Moreover, they should perform an active search for unusual gynecologic and anorectal signs and symptoms. Most importantly, patients undergoing mesh repair procedures must be warned of the risks of the surgery, including the possibility of several subsequent interventions.

Authors+Show Affiliations

Department of Obstetrics, Gynecology, and Reproductive Medicine, CHU Estaing, Clermont-Ferrand, France. Electronic address: marta@kemp.med.br.Department of Obstetrics, Gynecology, and Reproductive Medicine, CHU Estaing, Clermont-Ferrand, France.Department of Obstetrics, Gynecology, and Reproductive Medicine, CHU Estaing, Clermont-Ferrand, France.Department of Obstetrics, Gynecology, and Reproductive Medicine, CHU Estaing, Clermont-Ferrand, France.Department of Obstetrics, Gynecology, and Reproductive Medicine, CHU Estaing, Clermont-Ferrand, France.Department of Obstetrics, Gynecology, and Reproductive Medicine, CHU Estaing, Clermont-Ferrand, France.

Pub Type(s)

Case Reports
Journal Article
Video-Audio Media

Language

eng

PubMed ID

28087481

Citation

Kemp, Marta Maria, et al. "Transrectal Mesh Erosion Requiring Bowel Resection." Journal of Minimally Invasive Gynecology, vol. 24, no. 5, 2017, pp. 717-721.
Kemp MM, Slim K, Rabischong B, et al. Transrectal Mesh Erosion Requiring Bowel Resection. J Minim Invasive Gynecol. 2017;24(5):717-721.
Kemp, M. M., Slim, K., Rabischong, B., Bourdel, N., Canis, M., & Botchorishvili, R. (2017). Transrectal Mesh Erosion Requiring Bowel Resection. Journal of Minimally Invasive Gynecology, 24(5), 717-721. https://doi.org/10.1016/j.jmig.2017.01.002
Kemp MM, et al. Transrectal Mesh Erosion Requiring Bowel Resection. J Minim Invasive Gynecol. 2017 Jul - Aug;24(5):717-721. PubMed PMID: 28087481.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transrectal Mesh Erosion Requiring Bowel Resection. AU - Kemp,Marta Maria, AU - Slim,Karem, AU - Rabischong,Benoît, AU - Bourdel,Nicolas, AU - Canis,Michel, AU - Botchorishvili,Revaz, Y1 - 2017/01/10/ PY - 2016/12/13/received PY - 2016/12/22/revised PY - 2017/01/04/accepted PY - 2017/1/15/pubmed PY - 2018/1/18/medline PY - 2017/1/15/entrez KW - Erosion KW - Genital prolapse KW - Mesh KW - Rectal SP - 717 EP - 721 JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol VL - 24 IS - 5 N2 - STUDY OBJECTIVE: To report a case of a transrectal mesh erosion as complication of laparoscopic promontofixation with mesh repair, necessitating bowel resection and subsequent surgical interventions. INTRODUCTION: Sacrocolpopexy has become a standard procedure for vaginal vault prolapse [1], and the laparoscopic approach has gained popularity owing to more rapid recovery and less morbidity [2,3]. Mesh erosion is a well-known complication of surgical treatment for prolapse as reported in several negative evaluations, including a report from the US Food and Drug Administration in 2011 [4]. Mesh complications are more common after surgeries via the vaginal approach [5]; nonetheless, the incidence of vaginal mesh erosion after laparoscopic procedures is as high as 9% [6]. The incidence of transrectal mesh exposure after laparoscopic ventral rectopexy is roughly 1% [7]. The diagnosis may be delayed because of its rarity and variable presentation. In addition, polyester meshes, such as the mesh used in this case, carry a higher risk of exposure [8]. CASE REPORT: A 57-year-old woman experiencing genital prolapse, with the cervix classified as +3 according to the Pelvic Organ Prolapse Quantification system, underwent laparoscopic standard sacrocolpopexy using polyester mesh. Subtotal hysterectomy and bilateral adnexectomy were performed concomitantly. A 3-year follow-up consultation demonstrated no signs or symptoms of erosion of any type. At 7 years after the surgery, however, the patient presented with rectal discharge, diagnosed as infectious rectocolitis with the isolation of Clostridium difficile. She underwent a total of 5 repair surgeries in a period of 4 months, including transrectal resection of exposed mesh, laparoscopic ablation of mesh with digestive resection, exploratory laparoscopy with abscess drainage, and exploratory laparoscopy with ablation of residual mesh and transverse colostomy. She recovered well after the last intervention, exhibiting no signs of vaginal or rectal fistula and no recurrence of pelvic floor descent. Her intestinal transit was reestablished, and she was satisfied with the treatment. CONCLUSION: None of the studies that represent the specific female population submitted to laparoscopic promontofixation with transrectal mesh erosion describe the need for more than one intervention or digestive resection [9-12]. Physicians dealing with patients submitted to pelvic reconstructive surgeries with mesh placement should be aware of transrectal and other nonvaginal erosions of mesh, even being rare events. Moreover, they should perform an active search for unusual gynecologic and anorectal signs and symptoms. Most importantly, patients undergoing mesh repair procedures must be warned of the risks of the surgery, including the possibility of several subsequent interventions. SN - 1553-4669 UR - https://www.unboundmedicine.com/medline/citation/28087481/Transrectal_Mesh_Erosion_Requiring_Bowel_Resection_ DB - PRIME DP - Unbound Medicine ER -