Laparoscopic Excision and Re-Attachment of Sacrocolpopexy Mesh

Abstract

Study Objective To describe two cases and demonstrate surgical techniques for recurrent pelvic organ prolapse after minimally invasive sacrocolpopexy. Design N/A Setting Academic affiliated hospital. Patients or Participants Two patients with recurrent pelvic organ prolapse after minimally invasive sacrocolpopexy. Interventions A laparoscopic approach was taken for surgical intervention with excision of prior detached vaginal mesh and re-attachment of new sacrocolpopexy mesh to either the sacrum or prior sacral portion of the mesh. Measurements and Main Results Two patients presented with recurrent pelvic organ prolapse after failed surgical treatment. The first case is a 68-year old vaginal multipara with recurrent pelvic organ prolapse status post laparoscopic supracervical hysterectomy, sacrocolpopexy and mid-urethral sling performed at an outside institution. Preoperative physical examination revealed stage 3 prolapse. Mesh was found to be loosely attached to the cervix. After surgical correction, postoperative physical examination revealed stage 1 prolapse. The second case is 62-year old vaginal multipara with recurrent pelvic organ prolapse status post total laparoscopic hysterectomy and sacrocolpopexy at an outside institution. Preoperative physical examination revealed stage 2 prolapse. The vaginal portion of the mesh was also found to be attached only to the cervix. After surgical correction, postoperative physical examination revealed stage 0 prolapse. Both patients reported improvement in symptoms and overall quality of life. Conclusion Surgical management of recurrent pelvic organ prolapse after failed initial sacrocolpopexy procedure can be safely accomplished laparoscopically through identification of points of mesh detachment, anatomical landmarks, removal of the prior vaginal portion of the mesh, and attachment of a new surgical mesh to either the sacrum or sacral portion of the mesh.