Introduction and Objectives: With the recent FDA warnings about the use of mesh in vaginal surgery, concern about the risks associated with transvaginal mesh procedures has increased, especially with respect to the posterior compartment. The objective is to identify complications associated with vaginal rectocele repairs using mesh.
Methods: The records of two fellowship trained female pelvic floor surgeons were reviewed from 2009−2012 identifying patients that had undergone transvaginal rectocele repairs with mesh. Data collection included patient age, grade of prolapse, symptoms, mesh type, follow−up and specific characteristics of complications.
Results: 80 patients underwent transvaginal rectocele repairs with mesh using Elevate in 73 (91.25%%), Exair in five (6.25%), Prolift in one (1.25%), and Avaulta in one (1.25%). Average age was 64 yrs (range 39−88). 43/80 (54%) patients underwent a posterior mesh repair only, while 37/80 (46%) underwent combined posterior/anterior/apical mesh repairs. Preoperative grade was GI in six (7.5%), GII in 37 (46.25%), GIII in 29 (36.25%), and GIV in seven (8.75%). All patients were symptomatic with vaginal bulge, constipation, stool trapping, splinting and/or pelvic pressure. Mean follow−up was 10.6 months (range 0.4 to 36). Overall complication rate was 22% (18/80), with most deemed minor. Specific mesh−related complications were seen in only 10% of patients (8/80). Complications included hematoma in 2/80 cases (2.5%), intra−operative rectal injury in 1/80 (1%), posterior vaginal mesh exposure in 8/80 (10%), UTI in 3/80 (4%), transient de novo dyspareunia in 1/80 (1%) and de novo pelvic pain in 2/80 (2.5%). One pain patient complained of sacral and coccyx pain (later identified as being associated with bulging disc injury) and the other had initial exacerbation of chronic right hip pain, which resolved following manual therapy. Vaginal mesh extrusions were managed with simple office excision and the use of estrogen cream in all cases except one, which did require excision in the operating room. No patients developed prolapse recurrence in the posterior compartment and all had resolution of their related symptoms at the time of follow−up.
Conclusions: In the appropriately selected patient vaginal mesh can be safely used for rectocele repair with good success and minimal complications. Specific mesh−related complication rates are low and most often involve incision−related mesh extrusions, which can usually be handled via office excision and topical estrogen.
Clinical Relevance: Pelvic Organ Prolapse
Feb 25 2014 - Mar 1 2014
Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction