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Complete Excision of Sacrocolpopexy Mesh With Autologous Fascia Sacrocolpopexy

  • Janine L. Oliver
    Correspondence
    Address correspondence to: Janine L. Oliver, M.D., Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, University of California-Los Angeles Medical Center, David Geffen School of Medicine at University of California-Los Angeles, 200 UCLA Medical Plaza, Suite 140, Los Angeles, CA 90095.
    Affiliations
    Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, University of California-Los Angeles Medical Center, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA
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  • Zaid Q. Chaudhry
    Affiliations
    Division of Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, University of California-Los Angeles Medical Center, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA
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  • Andrew R. Medendorp
    Affiliations
    Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, University of California-Los Angeles Medical Center, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA
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  • Lauren N. Wood
    Affiliations
    Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, University of California-Los Angeles Medical Center, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA
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  • Z. Chad Baxter
    Affiliations
    Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, University of California-Los Angeles Medical Center, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA
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  • Ja-Hong Kim
    Affiliations
    Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, University of California-Los Angeles Medical Center, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA
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  • Shlomo Raz
    Affiliations
    Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, University of California-Los Angeles Medical Center, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA
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      Objective

      To evaluate the safety and short-term efficacy of complete sacrocolpopexy mesh excision with concomitant autologous fascia sacrocolpopexy.

      Methods

      A retrospective cohort study of patients undergoing complete sacrocolpopexy mesh excision and concomitant autologous fascia sacrocolpopexy from March 2013 to September 2016 was conducted. The primary objective was assessment of perioperative outcomes including complications within 60 days of surgery. The secondary outcome measure was surgical success defined as no need for retreatment by either surgery for apical prolapse or pessary.

      Results

      Nineteen patients were identified. Median patient age was 56 years old (range 35-78). Median time from mesh placement to surgical excision was 4.5 years (0-13). Indications for mesh excision included refractory pelvic pain in 18 patients (95%), symptomatic mesh exposure in 8 patients (42%), and bilateral ureteral obstruction with ureterovaginal fistula in 1 patient (5%). Median operative time, estimated blood loss, and length of hospital stay were 228 minutes (133-362), 200 mL (50-1000), and 5 days (2-9), respectively. The rate of minor and major complications within 60 days was 36.8% and 5.3%, respectively. There were no cases of bladder or bowel injury. At a median follow-up of 9.9 months (2.4-39) no patient required secondary surgery for apical vaginal prolapse or retreatment with pessary.

      Conclusion

      Complete sacrocolpopexy mesh excision with concomitant autologous fascia sacrocolpopexy can be accomplished safely with a low rate of major complications. These are short-term findings and longer follow-up of anatomic and functional outcomes is needed.
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