Hematometra After Mesh Laparoscopic Sacrohysteropexy, a Rare Complication?

Abstract

L aparoscopic mesh sacrohysteropexy (LSH) is an increasingly popular surgical option for the management of uterine prolapse. For women in whom first-line conservative measures fail, it has evolved as an alternative to the vaginal hysterectomy with apical suspension, to date the preferred surgical approach. However, vaginal hysterectomy is known to be associated with a high risk of recurrent prolapse with reoperation rates as high as 30%, laparoscopic sacrohysteropexy offerswomen the additional option of uterine preservation. A mesh prosthesis is generally used for abdominal hysteropexy, following on from U.S. Food and Drug Administration approval in 2002 of mesh devices for prolapse. Such abdominal mesh-augmented approaches were adopted to try and address the issue of high rates of reoperation with native tissue repair. Although approaches to LSH continue to evolve as the field advances, the Oxford technique involves cervical encerclage. This theoretically reduces the risk of mesh avulsion from the cervix, but more importantly avoids the placement of mesh in direct contact with the vagina, in an attempt to avoid vaginal mesh extrusion. The role of mesh-augmented prolapse surgery has been subject to scrutiny and attention given the risk of mesh-associated complications, which are particularly high after transvaginal placement of mesh. The recent large multicenter randomized controlled trial, the Prolapse Surgery: Pragmatic Evaluation and Randomised Controlled Trials (PROSPECT) study, compared synthetic and biological graft-augmented prolapse repair against native tissue techniques. The study found no improvement in outcomes with regard to effectiveness or quality of life with the use of transvaginal mesh, however, 1 in 10 women had some form of mesh complication. This corroborates concerns raised by various independent governmental reports in the United Kingdom and elsewhere. Reports have highlighted complications, including mesh exposure or extrusion, vaginal bleeding or discharge, pain, dyspareunia, and bladder and bowel symptoms. There are also reports of neuromuscular sequelae, vaginal scarring, and shrinkage of the mesh implant. These findings highlight the need to critically appraise the risk of mesh-associated complications after all forms of mesh-augmented prolapse surgery. To date, there are limited publications detailing the complications that can occur after LSH. Our recent multicenter crosssectional study of 1,121 women who underwent LSH found an