Anterior and posterior laparoscopic mesh removal due to pelvic pain, subtotal hysterectomy, mesh replacement, and Burch procedure
Epublication WebSurg.com, Jan 2015;15(01). URL: http://websurg.com/doi/vd01en4400
This is the case of a 69-year-old woman presenting with pelvic pain after laparoscopic sacrocolpopexy. The patient has a history of one vaginal birth, laparoscopic sacrocolpopexy with uterine preservation combined with a transobturator tape (TOT) sling procedure performed in 2013. The following symptoms appeared after surgery: invalidating pelvic pain, especially in an upright position, severe terminal constipation, worsening of a previously mild stress urinary incontinence. On clinical examination, a high rectocele (grade 2/3), a cystocele, and elective pain at the level of the TOT sling were observed. MRI revealed a perineal inflammation between the anterior aspect of the vagina and the urethra, at the level of the lower third of the urethra. A fibrotic area can be noted at the level of the rectovaginal space. Her TOT sling was partially resected in January 2014. Cystoscopy ruled out the presence of mesh erosion. Hysteroscopy was normal. Endometrial biopsy demonstrated an atrophic endometrium. In this surgery, the anterior and posterior meshes are removed. A subtotal hysterectomy combined with the replacement of meshes were performed, followed by a Burch procedure.