Partial colpocleisis for the treatment of sacrocolpopexy mesh erosions

Abstract

The purpose of this study is to describe the outcomes of partial colpocleisis for mesh erosions after sacrocolpopexy. We retrospectively report our surgical management of mesh erosion after sacrocolpopexy. Between 1998 and 2006, we performed 499 sacral colpopexies and treated 21 patients for mesh erosion, including three referrals. Mean (range) time to diagnosis was 10.3 months (1–49). Grafts materials included: Mersilene (13), Prolene (7), and Pelvicol (1). Surgical outcomes were available for 19 patients. Ten (48%) patients were cured by the initial partial colpocleisis, while nine (45%) required a second or third (2, 10%) vaginal operation. All of the second and third vaginal excisions failed. Eight patients had an abdominal excision, and two patients required a second abdominal procedure. The success rate for the first and second abdominal resections was 38% (3/8) and 100% (2/2). Abdominal surgeries had higher blood loss (84 vs 378 cc, p = 0.012) longer hospitalization (outpatient vs 4.2 days p = 0.001), and additional morbidity (18.6%). Potential contributing factors to surgical failure were the presence of Actinomyces and current smoking. We recommend initial transvaginal mesh resection with partial colpocleisis for synthetic mesh erosions after sacrocolpopexy. Vaginal failures may be better served by an abdominal excision. Potential contributors to failure include current smoking and the presence of Actinomyces.