Different management strategies for postoperative hematoma after pelvic organ prolapse surgery

Abstract

The lifetime risk of a single operation for pelvic organ prolapse (POP) or incontinence is approximately 11% [1]. Additionally, the reoperation rate for symptomatic recurrence is approximately 30e40%. New techniques are continually being developed to resolve these conditions. The combination of novel and traditional techniques in this highly vascularized area renders acute hemorrhage a challenging complication. This report describes a patient with POP who underwent two different operations and developed a hematoma after each operation. Embolization with conservative management after the first operation, and exploration and ligation of the bleeding artery after the second operation were performed. Different management strategies for these postoperative hematomas in this case are discussed. A 50-year-old female, G2P2, had stage 2 POP [Aa, 0; Ba, 0; Ap, 0; Bp, 0; C, e5; D, e7; genital hiatus (gh), 2; perineal body (pb), 3; and total vaginal length (tvl), 8]. She underwent a pelvic reconstruction operation with an unanchored mesh (Prosima; Ethicon, Somerville, NJ, USA). Surgeons placed grafts according to the manufacturer’s instructions. The procedures were smooth during anterior Prosima placement. However, during the posterior dissection, an expected amount of bleeding was noted and was controlled following compression. Cystoscopy after anterior repairs, digital rectal examination after posterior repairs, and a two-layer closure of the vaginal fibromuscular layer and superficial squamous epithelial layer were performed. The trapezium-shaped vaginal supporting device (VSD) has trimmable sections that conformed to the upper two-thirds of the vagina. The surgery took roughly 37 minutes and blood loss was less than 50 mL. No complaint was noted during that night following surgery.