Resection Of Mesh Research Articles

Utilizing Hysteroscopic Mesh Resection for Presacral Mesh Infection Following Sacrocolpopexy

Utilizing Hysteroscopic Mesh Resection for Presacral Mesh Infection Following Sacrocolpopexy

SJLA_2024_A16: Unusual Complications of Open Preperitoneal Tension-Free Inguinal Hernia Repair

Background: The purpose of this study is to report two patients referred to our hospital after developing unusual complications attributed to prior open preperitoneal tension-free inguinal hernia repair. Methods: Case # 1 A 75-year-old male developed a left proximal thigh abscess requiring incision and drainage 5 years after open prosthetic, preperitoneal inguinal hernia repair with single-layer mesh. A pelvic computed tomography (CT) scan demonstrated an abscess in the left inguinal preperitoneal space as well as diverticulosis but no diverticulitis. A colonoscopy was negative for any additional findings. The patient underwent groin exploration, debridement of the inguinal canal and sinus tract, and mesh resection followed by JP drain placement. The inguinal defect was repaired utilizing the should ice technique. Intraoperative cultures revealed penicillin-resistant Staphylococcus aureus. The drain was removed on postoperative day nine, and his recovery remains uneventful without hernia recurrence or infectious complications at 11-month follow-up. Case # 2 An 82-year-old man developed progressive left lower extremity edema and disabling claudication 1 month after open prosthetic inguinal hernia repair with a bilayer disc mesh. Venous duplex imaging revealed compression of the left common femoral and external iliac veins. A CT angiogram demonstrated left external iliac and common femoral artery thrombosis and a 5.2 cm fluid collection consistent with hematoma. An inferior vena cava filter was placed. The common femoral artery was controlled after initial exploration revealed a common femoral artery pseudoaneurysm. The mesh was densely adherent to the external iliac vein and was thus not resected. The common femoral artery pseudoaneurysm was repaired and the profunda femoris artery over sewn. An external iliac to superficial femoral artery 8 mm Polytetrafluoroethylene bypass graft was placed. The patient was discharged on systemic anticoagulation without claudication on postoperative day thirteen. Results: Laparoscopic inguinal hernia repair and novel, open techniques and mesh devices have popularized the placement of mesh in the preperitoneal space. Acute, severe vascular complications and latent infectious complications can occur after open, preperitoneal tension-free inguinal hernia repair and may require remedial surgery. CT scans and angiogram pictures are available. Discussion: Laparoscopic inguinal hernia repair and novel, open techniques and mesh devices have popularized the placement of mesh in the preperitoneal space. Acute, severe vascular complications and latent infectious complications can occur after open, preperitoneal tension-free inguinal hernia repair and may require remedial surgery. CT scans and angiogram pictures are available. Conclusion: Laparoscopic inguinal hernia repair and novel, open techniques and mesh devices have popularized the placement of mesh in the preperitoneal space. Acute, severe vascular complications and latent infectious complications can occur after open, preperitoneal tension-free inguinal hernia repair and may require remedial surgery. CT scans and angiogram pictures are available.

Robot-assisted repair of complicated inguinal hernia: Advantages in comparison with conventional repair

Abstract The adoption rate of robot-assisted surgery has skyrocketed in recent years, despite limited evidence, an unclear clinical benefit, and an increase in cost. The laparoscopic approach to inguinal hernia repair by either transabdominal or extraperitoneal approach has gradually gained traction owing to distinct advantages over traditional open repairs. Although robotic inguinal hernia repair has been established as a safe alternative to conventional laparoscopy, as of yet no superiority has been proven. We aim to give an overview of certain clinical situations, in which the robot might be advantageous. Specifically, we discuss inguinoscrotal hernia repair, inguinal hernia repair after prostatectomy, and mesh explantation. In our opinion, robotic systems are an invaluable tool in the case of mesh resection or recurrence after previous anterior and posterior repairs. With the increased expansion of the surgical tools and techniques to repair abdominal wall problems, a definitive and clear rule as to which cases should be handled robotically and which should not will be difficult and probably unattainable. We are very much proponents of a tailored approach, where every individual case deserves its surgical plan, bearing in mind all aspects of a patient, with the aim of the best surgical outcome.

V-050 WEDGE RESECTION AND CLOSURE OF ENTEROCUTANEOUS SMALL BOWEL FISTULA CONTAINING MESH FOLLOWING PREVIOUS INCISIONAL HERNIA REPAIR

Abstract Aim To demonstrate a technique to manage complications of mesh migration into bowel and subsequent enterocutaneous fistula following incisional hernia repair that avoids large laparotomy, adhesiolysis, removal of all abdominal wall mesh, and risk of bowel injury. Methods A 74 year old developed an enterocutaneous fistula with migration of mesh into the small bowel following an incisional hernia repair with sublay mesh. She’d previously had multiple laparotomies and subsequently turned down for surgical management of her fistula due to the hostile nature of her abdomen and complication risk. She developed pancreatitis and the increase in intra-abdominal pressure made her fistula unmanageable. Following a period of parental feeding and a contrast follow-through study, surgery to resect the fistula containing mesh and primary closure with minimal adhesiolysis was performed. Results Subcutaneous tissue around the fistula was resected down to fascia. Bowel was mobilised 5cm and a foley catheter inserted to check diameter. Mesh was resected with part of the small bowel which was then closed. Pre-peritoneal space was dissected to remove a further segment of mesh invading bowel. Posterior rectus sheath was cleared for 5cm before abdominal wall closure in 3 layers. No complaints or problems reported after 2 years follow-up. Conclusions This technique avoids laparotomies, associated adhesiolysis and large enterectomy with the associated risks. A limited wedge resection of mesh and small bowel for enterocutaneous fistula can be done and eliminates the need to remove all abdominal wall mesh in such scenarios. Another tool in the arsenal for complex patients.

A Comparison of Perineal Myocutaneous Flaps Following Abdominoperineal Excision of the Rectum for Anorectal Pathology.

Flap-based reconstruction following abdominoperineal resection has been used to address the resultant soft tissue defect and reduce postoperative wound complications. Vertical rectus abdominis myocutaneous flaps have been the traditional choice, but locoregional flaps have attracted attention in minimally invasive resection because they avoid additional abdominal dissection. However, few data exist comparing flap types. To compare outcomes for different types of perineal reconstruction in patients undergoing abdominoperineal resection exclusively for anorectal pathology. This was a retrospective comparative study. This study was conducted at a large, tertiary referral institution. Following Institutional Review Board approval, prospectively maintained clinical and financial databases were interrogated and cross-referenced for patients undergoing proctectomy or abdominoperineal resection with flap reconstruction from 2007 to 2018. Patients with primary gynecological or urological pathology were excluded. The primary outcome was flap complication rate. Secondary outcomes included perineal hernia rate, donor site complications, emergency department consult after discharge, readmission <90 days, and length of stay. Data were analyzed using univariate and multivariate techniques. A total of 135 patients (79 female, median age 58 years) were included: 68 rectus, 52 gluteal, and 15 gracilis flap reconstructions. Median follow-up was 46 months. Rates of both major and minor flap complications were similar for rectus and gluteal flaps, even when controlling for differences between groups via multivariate analysis ( p > 0.9), including extent of resection and use of mesh. For all flaps, American Society of Anesthesiology score ≥3 was the only independent predictor of major, but not minor, flap complications. For rectus and gluteal flaps, smoking, female sex, and American Society of Anesthesiology score ≥3 were independent predictors of major flap complications ( p < 0.05). This study was limited by its retrospective nature and potential selection bias associated with flap choice; it was also impossible to quantify defect size. Gluteal flaps have similar complication rates to rectus flaps and may be considered for patients who are otherwise suitable for minimally invasive abdominoperineal resection. See Video Abstract at http://links.lww.com/DCR/B866 .Una comparación de los colgajos miocutáneos perineales después de la escisión abdominoperineal del recto para patología anorectal. La reconstrucción con colgajo después de la resección abdominoperineal se ha utilizado para abordar el defecto de tejido blando resultante y reducir las complicaciones postoperatorias de la herida. Los colgajos miocutáneos verticales del recto abdominal han sido la elección tradicional, pero los colgajos locorregionales han atraído la atención en la resección mínimamente invasiva porque evitan la disección abdominal adicional. Sin embargo, existen pocos datos que comparen los tipos de colgajos.

Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement.

BackgroundThe incidence of incisional hernia after major abdominal surgery via a midline laparotomy is 20–41 per cent with short-term follow-up, and over 50 per cent in those surviving an abdominal catastrophe. Abdominal wall reconstruction (AWR) requires complex operations, often involving mesh resection, management of scarred skin, fistula takedown, component separation or flap reconstruction. Patients tend to have more complex conditions, with multiple co-morbidities predisposing them to a vicious cycle of complications and, subsequently, hernia recurrence. Currently there appears to be variance in perioperative practice and minimal guidance globally. The aim of this Delphi consensus was to provide a clear benchmark of care for the preoperative assessment and perioperative optimization of patients undergoing AWR.MethodsThe Delphi method was used to achieve consensus from invited experts in the field of AWR. Thirty-two hernia surgeons from recognized hernia societies globally took part. The process included two rounds of anonymous web-based voting with response analysis and formal feedback, concluding with a live round of voting followed by discussion at an international conference. Consensus for a strong recommendation was achieved with 80 per cent agreement, and a weak recommendation with 75 per cent agreement.ResultsConsensus was obtained on 52 statements including surgical assessment, preoperative assessment, perioperative optimization, multidisciplinary team and decision-making, and quality-of-life assessment. Forty-six achieved over 80 per cent agreement; 14 statements achieved over 95 per cent agreement.ConclusionClear consensus recommendations from a global group of experts in the AWR field are presented in this study. These should be used as a baseline for surgeons and centres managing abdominal wall hernias and performing complex AWR.

23 Repeat minimally invasive abdominal sacrocolpopexy for recurrent prolapse

The objective of this video is to demonstrate techniques for minimally invasive abdominal sacrocolpopexy for recurrent pelvic organ prolapse after prior sacrocolpopexy. Sacrocolpopexy is considered by many to be the gold standard for repair of apical pelvic organ prolapse. Although rates of surgical failure and repeat surgery are low, prolapse recurrence can occur after sacrocolpopexy. In this video, we review recurrence rates of prolapse after minimally invasive abdominal sacrocolpopexy (MI-SCP), discuss two cases of prolapse recurrence following MI-SCP and subsequent surgical repair of recurrence with repeat MI-SCP, and present clinical tips and tricks for repeat MI-SCP. Through both cases, we illustrate three key principles for approaching a repeat MI-SCP: assessment of prior surgical repair and identification of cause of anatomic failure, re-establishment of normal anatomy via lysis of adhesions, and resection of prior mesh and/or attachment of new mesh. The use of robotic assistance for dissection is also demonstrated. Despite the high durability of sacrocolpopexy, prolapse recurrence can still occur over time. Appropriate cases of prolapse recurrence can be managed in a minimally invasive manner with repeat MI-SCP.

Caesarean Scar Endometriosis May Require Abdominoplasty

Endometriosis is defined as an ectopic presence of endometrium-like tissue outside uterine cavity, which most commonly involves intraperitoneal organs. However, one of the less frequent forms of the disease is abdominal wall endometriosis usually developing in surgical scars following obstetric and gynaecological surgeries involving uterine cavity entering, that is, caesarean section, myomectomy or hysterectomy. In this case report we present a case of a patient with extensive caesarean scar endometriosis, who required complex surgical management. Successful surgical treatment involved not only radical tumour resection and application of mesh in postoperative hernia prevention but also adequate wound closure ensuring satisfactory cosmetic results, which was most challenging. The abdominal wall defect could not be sutured by traditional technique, thus polypropylene mesh was used and partial abdominoplasty was performed. The wound healed without complication and 24-month follow-up showed no evidence of local recurrence and satisfactory cosmetic result. In case of extensive endometrial abdominal wall tumours surgical treatment may involve application of advanced plastic surgery techniques, like abdominoplasty or skin/musculocutaneous flaps transposition.

Management of Vaginal Mesh Exposures Following Female Pelvic Reconstructive Surgery.

To discuss considerations and current evidence for the diagnosis and management of vaginal mesh exposures following female mesh-augmented anti-incontinence and pelvic organ prolapse surgery. Since the introduction of mesh into female pelvic surgery, various applications have been reported, each with their own unique risk profile. The most commonly encountered mesh-related complication is vaginal mesh exposure. Current evidence on the management of vaginal mesh exposure is largely limited to observational studies and case series, though this is continuing to expand. We present a synthesis of the available data, as well as clinical and surgical approaches to managing this complication. It is important for surgeons to be familiar with the management of vaginal mesh exposures. Depending on thepatient's presentation and goals, there is a role for conservative measures, mesh revision, or mesh excision. Further study is warranted to standardize mesh resection techniques and explore non-surgical treatments.

Laparoscopic Sacrocolpopexy Mesh Removal for Immediate Onset of Pelvic Pain after Operation

Study Objective To demonstrate laparoscopic excision of sacrocolpopexy mesh for persistent pelvic pain immediately onset after operation. Design Case report. Setting University hospital. Patients or Participants A 62-year-old woman from China. Interventions Laparoscopic resection of sacrocolpopexy mesh. Measurements and Main Results The patient complained immediate onset of pelvic pain after a laparoscopic hysterectomy, bilateral salpingectomy, and sacrocolpopexy for middle compartment pelvic organ prolapse 2 years earlier. A polypropylene mesh was used in the operation. The pain was obvious when walking and doing housework, especially when the hands were raised over the head, and relieved when resting or lying still. She had no sex for 2 years. Physical examination revealed excessive tensioning of mesh. MRI suggested no evidence of bowel obstruction, osteomyelitis, and mesh infection or exposure. At laparoscopy, a well-reperitonealized mesh was noted to begin in the vaginal vault and be fixed to the sacrum at S1 along the right pelvic wall (lateral to the uterine sacral ligament), with excessive tensioning. Surgical steps begin with laparoscopic survey of the anatomy, followed by release of adhesions. After carefully dissecting the right ureter, the mesh was transected close to the sacral promontory and resected at the level of the vaginal cuff angles. A small portion of the mesh was left to fix the vaginal vault to the right pelvic wall. The operative time was 90 min, with 20 ml blood loss. There were no complications. She was discharged on post-operative day 2. On follow-up one month later, there was complete resolution of her symptoms, and 8 months till now with no vault descent. Conclusion This video demonstrates the steps required to perform a partial laparoscopic sacrocolpopexy mesh excision. This may provide a feasible treatment strategy for similar patients in the future.

Efficacy of surgical revision of mesh complications in prolapse and urinary incontinence surgery

Introduction and hypothesisWomen with mesh-related complications in prolapse (POP) and stress-urinary incontinence (SUI) surgery may benefit from operative mesh resection to alleviate symptoms. We hypothesized that mesh resection would alleviate symptoms and aimed to evaluate risks and benefits in these women.MethodsWe carried out a cross-sectional study. Primary outcome was improvement specified as better, unchanged or worsened symptoms after mesh revision surgery. Secondary outcomes were health-related quality of life (HrQol) scores of validated questionnaires, surgical characteristics and physical findings at follow-up visits. Descriptive data were reported with mean and medians. Associations were calculated with Spearman correlation coefficient and chi-square test to determine statistical differences between groups.ResultsFifty-nine women who underwent mesh revision surgery between 2009 and 2016 were included. After a median follow-up of 1.7 (IQR: 1.1–2.4) years, 44 women (75%) reported improvement of symptoms. No significant surgical or patient characteristics were identified that could differentiate which patients did or did not experience cure or complications.A trend was observed to better HrQol scores in women who reported overall improvement after mesh revision surgery. Seventeen (29%) women needed a subsequent operation after mesh removal.ConclusionsThis cross-sectional study shows that mesh revision surgery alleviates symptoms in 75% of women with mesh-related complications. Type of revision surgery and individual characteristics did not seem to matter to the individual chance of cure or complications. These data can facilitate the counseling of women considering mesh revision surgery.

Long-term mesh erosion rate following abdominal robotic reconstructive pelvic floor surgery: a prospective study and overview of the literature

Introduction and hypothesisThe use of synthetic mesh in transvaginal pelvic floor surgery has been subject to debate internationally. Although mesh erosion appears to be less associated with an abdominal approach, the long-term outcome has not been studied intensively. This study was set up to determine the long-term mesh erosion rate following abdominal pelvic reconstructive surgery.MethodsA prospective, observational cohort study was conducted in a tertiary care setting. All consecutive female patients who underwent robot-assisted laparoscopic sacrocolpopexy and sacrocolporectopexy in 2011 and 2012 were included. Primary outcome was mesh erosion. Preoperative and postoperative evaluation (6 weeks, 1 year, 5 years) with a clinical examination and questionnaire regarding pelvic floor symptoms was performed. Mesh-related complications were assessed using a transparent vaginal speculum, proctoscopy, and digital vaginal and rectal examination. Kaplan–Meier estimates were calculated for mesh erosion. A review of the literature on mesh exposure after minimally invasive sacrocolpopexy was performed (≥12 months’ follow-up).ResultsNinety-six of the 130 patients included (73.8%) were clinically examined. Median follow-up time was 48.1 months (range 36.0–62.1). Three mesh erosions were diagnosed (3.1%; Kaplan–Meier 4.9%, 95% confidence interval 0–11.0): one bladder erosion for which mesh resection and an omental patch interposition were performed, and two asymptomatic vaginal erosions (at 42.7 and 42.3 months) treated with estrogen cream in one. Additionally, 22 patients responded solely by questionnaire and/or telephone; none reported mesh-related complaints. The literature, mostly based on retrospective studies, described a median mesh erosion rate of 1.9% (range 0–13.3%).ConclusionsThe long-term rate of mesh erosion following an abdominally placed synthetic graft is low.

Vaginal laser therapy - hype or established treatment?

Noninvasive treatment is recommended as first line for urinary incontinence (UI) in women. However, surgical procedures are more likely to be implemented to cure UI but are associated with more adverse events. Less invasive operative mesh techniques are relatively effective, but not immune to complications such as bleeding, bladder perforation, urethral injury, infection, and the retention requiring mesh resection. In patients for whom the risks of anesthesia and surgery are too high, a minimally invasive approach is recommended and further research is needed in terms of more compliant, less invasive and low-cost methods for the treatment of stress UI and pelvic floor dysfunction.

A Case of Chronic Pain after Inguinal Herniorrhaphy Treated Successfully with Mesh Resection and Triple Neurectomy

鼠径ヘルニア術後の慢性疼痛は，患者のQOLを著しく低下させる重篤な合併症である．今回，鼠径ヘルニア術後の慢性疼痛に対して，メッシュ除去術および神経切離術を行い，著明な除痛が得られた1例を経験したので報告する．症例は77歳の男性で，右腎癌治療に伴う慢性腎不全で血液維持透析中であった．左内鼠径ヘルニアに対して鼠径ヘルニア修復術（Mesh Plug法）を施行した．術後3カ月で左鼠径部痛が出現した．左鼠径部の異常感覚と左鼠径部から左大腿内側にかけての放散痛を認めたことから，神経因性の慢性疼痛と診断した．鎮痛剤による内服加療が奏効せず，初回手術より5カ月でメッシュ除去術および神経切離術を施行した．手術直後より著明な除痛が得られた．病理組織学的検査では，陰部大腿神経陰部枝周囲に広範な脂肪壊死および瘢痕化所見を認め，そこへ向かって同神経が牽引されていたことから，今回の神経因性疼痛の原因の一つと考えられた．

Concomitant open ventral hernia repair: what is the financial impact of performing open ventral hernia with other abdominal procedures concomitantly?

Open ventral hernia repair (VHR) is often performed in conjunction with other abdominal procedures. Clinical outcomes and financial implications of VHR are becoming better understood; however, financial implications of concomitant VHR during other abdominal procedures are unknown. This study aimed to evaluate the financial implications of adding VHR to open abdominal procedures. This IRB-approved study retrospectively reviewed hospital costs to 180-day post-discharge of standalone VHRs, isolated open abdominal surgeries (bowel resection or stoma closure, removal of infected mesh, hysterectomy or oophorectomy, panniculectomy or abdominoplasty, open appendectomy or cholecystectomy), performed at our institution from October 1, 2011 to September 30, 2014. The perioperative risk data were obtained from the local National Surgery Quality Improvement Program (NSQIP) database, and resource utilization data were obtained from the hospital cost accounting system. 345 VHRs, 1389 open abdominal procedures as described, and 104 concomitant open abdominal and VHR cases were analyzed. The VHR-only group had lower ASA Class, shorter operative duration, and a higher percentage of hernias repaired via separation of components than the concomitant group (p < 0.001). The median hospital cost for VHR-alone was $12,900 (IQR: $9500-$20,700). There were significant increases to in-hospital costs when VHR was combined with removing an infected mesh (63%) or with bowel resections or stoma closures (0.7%). The addition of VHR did not cause a significant change in 180-day post-discharge costs for any of the procedures. This study noted decreased costs when combining VHR with panniculectomy or abdominoplasty and hysterectomy or oophorectomy. For removal of infected mesh and bowel resection or stoma closure, waiting, when feasible, is recommended. Given the impending changes in financial reimbursements in healthcare in the United States, it is prudent that future studies evaluate further the clinical and fiscal benefit of concomitant procedures.

Transvaginal Resection of an Infected Sacrocolpopexy Mesh by Single-Port Trocar

Study ObjectiveLaparoscopy using a single port improves morbidity while keeping the same level of requirement. This technique has been evaluated in gynecology for salpingectomy, ovarian surgery, and hysterectomy. Here, the authors illustrate a new use of a single port using the transvaginal approach. DesignCase report (Canadian Task Force classification III). SettingTertiary referral center in Strasbourg, France. PatientWoman age 59 years. InterventionSingle-port platform used in the transvaginal approach for resection of sacrocolpopexy mesh. The local institutional review board approved the video. Measurements and Main ResultsA 59-year-old woman suffering from insulin-dependent diabetes and a tobacco user had 2 laparoscopic sacrocolpopexies for recurrent rectocele, the first in 2007 and the second in 2012. The sequences were marked by mesh erosion and granuloma in the vagina, requiring its surgical excision in 2016. The patient was then symptomatic, with an increasingly foul-smelling vaginal discharge with recurrent mesh erosion. Magnetic resonance imaging showed an abscess formation along the length of the mesh to the promontory. The patient then underwent surgery, realized under probabilistic antibiotic therapy, consisting of complete excision of the sacrocolpopexy mesh by the transvaginal approach. After putting the single-port trocar (GelPoint; Applied Medical, Rancho Santa Margarita, CA) into the vagina and obtaining distension with the insufflator (AirSeal; Conmed, Utica, NY), classic laparoscopic instruments were introduced by the single-port trocar. The mesh was entirely resected in the retroperitoneal space. Mesh was again used because the exposed space is almost always surrounded by loose granulation tissue that facilitates dissection and also prevents injury to adjacent structures such as bladder, rectum, and peritoneum. Moreover, the opening of adjacent structures will manifest gas leaks and, consequently, loss of the pneumovagina. At the end of procedure, the vagina is not closed to permit optimal drainage with a multitubular drain in the dissection space. The surgery lasted 60 minutes. The mesh excision was completed with relative ease, and there was no blood loss. Bacteriologic examination revealed the presence of Streptococcus anginosus, Klebsiella pneumoniae, and Bacteroides fragili. The operating suites were simple with great cicatrization after 6 weeks. The principal difficulties of this surgery were obtaining a good seal by the creation of cutaneous sutures. Finally, there are less conflicts between the instruments inside the single-port trocar used in transvaginally because of a more limited dissection space. Indeed, the rate of mesh erosion reached 2.4% and, in case of infection, justifies this excision. ConclusionThe transvaginal use of a single-port trocar represents a good alternative, allowing easy resection of the sacrocolpopexy mesh while remaining in the retroperitoneal space.

Outcomes of transurethral resection (TUR) of intravesical mesh after suburethral slings in the treatment of urinary stress incontinence

ObjectiveThe objective of this study was to determine the efficacy as well as the complications associated with transurethral removal (TUR) of intravesical mesh, after suburethral sling, transobturator tape-TOT (Monarc™) or “minisling” (MiniArc®), in the treatment of female urinary stress incontinence (USI). Materials and methodsA retrospective and consecutive study on 9 women with bladder perforation after midurethral slings (3 Monarc™ and 6 MiniArc®) placement for urinary stress incontinence. To remove the mesh, transurethral resection with an electrode loop (TUR-E) was used. The technique included location and total removal of mesh up to healthy tissue with bipolar resectoscope. ResultsThe median age was 61 years (49–70 years). The median time between midurethral sling placement and onset of the symptoms was 13 months (1–79 months) and between sling placement and mesh removal it was 16 months (1–91 months). Five women (55.5%) developed bladder stones. Mean operating time was 29.4±10.4min and mean length of hospital stay was 2.6±0.5 days. The median follow-up after mesh removal was 38 months (range, 14–109 months). No complications were found. ConclusionsThe use of transurethral resection of intravesical mesh after suburethral slings is easy and the results obtained by our surgical team are excellent.

Management of Mesh Complications after SUI and POP Repair: Review and Analysis of the Current Literature.

Purpose. To evaluate the surgical treatment concepts for the complications related to the implantation of mesh material for urogynecological indications. Materials and Methods. A review of the current literature on PubMed was performed. Results. Only retrospective studies were detected. The rate of mesh-related complications is about 15–25% and mesh erosion is up to 10% for POP and SUI repair. Mesh explantation is necessary in about 1-2% of patients due to complications. The initial approach appears to be an early surgical treatment with partial or complete mesh resection. Vaginal and endoscopic access for mesh resection is favored. Prior to recurrent surgeries, a careful examination and planning for the operation strategy are crucial. Conclusions. The data on the management of mesh complication is scarce. Revisions should be performed by an experienced surgeon and a proper follow-up with prospective documentation is essential for a good outcome.

Resultados de la resección transuretral (RTU) de malla intravesical tras tratamiento con cintillas suburetrales para la incontinencia urinaria de esfuerzo

ObjectiveThe objective of this study was to determine the efficacy as well as the complications associated with transurethral removal (TUR) of intravesical mesh after suburethral sling, transobturator tape-TOT (Monarc™) or “minisling” (MiniArc®), in the treatment of female urinary stress incontinence (USI). Material and methodsretrospective and consecutive study on 9 women with bladder perforation after midurethral slings (3 Monarc™ and 6 MiniArc®) placement for urinary stress incontinence. To remove the mesh, transurethral resection with an electrode loop (TUR-E) was used. The technique included: location and total removal of mesh with bipolar resectoscope up to healthy tissue. ResultsThe median age was 61 years (49-70 years). The median time between midurethral sling placement and onset the sympltoms was 13 months (1-79 months). and between sling placement and mesh removal was 16 months (1-91 months). Five women (55.5%) developed bladder stones. Mean operating time was 29.4±10.4minutes and mean length of hospital stay was 2.6±0.5 days. The median follow-up after mesh removal was 38 months (range, 14 to 109 months). No complications were found. ConclusionsThe use of transurethral resection of intravesical mesh after suburethral slings is easy and the results obtained by our surgical team are excellent.

Bladder Erosion and Stone as Rare Late Complication of Laparoscopic Hernia Meshplasty: Is Endoscopic Management an Option?

As laparoscopic hernia repair is slowly becoming the norm in the management of inguinal hernia, its remotely possible long-term complications have started becoming evident. We report an asymptomatic hanging anterior bladder wall calculus, formed over a migrated hernia mesh into the bladder 16years after laparoscopic hernia repair and managed using holmium laser while performing transurethral resection of the prostate. There are only a few case reports in the literature regarding this issue, and the management suggested has been either periurethral cystoscopic pulling for extraction of the mesh or resection of mesh along with the bladder wall and cystorrhaphy. This is the first report of holmium laser being used for complete successful endourological management with a 2-year follow-up of protruded mesh in the bladder.