Laparoscopic Colposacropexy Mesh Excision Secondary to Severe Spondylodiscitis.

STUDY

OBJECTIVE

To describe laparoscopic mesh excision for severe spondylodiscitis secondary to colposacropexy mesh infection and demonstrate its feasibility.

DESIGN

Step-by-step description of the surgical procedure using an educational video.

SETTING

Spondylodiscitis is an uncommon and severe complication after sacrocolpopexy [1], with only 34 cases published to date [2]. Symptoms usually appear weeks after surgery, the most common being back pain irradiating toward the lower extremities and fever [3,4]. Treatment consists of intravenous antibiotic therapy for a minimum of 6 weeks, and approximately 70% require a surgical treatment [2] including mesh removal and debridement of the necrotic material [5].

INTERVENTIONS: A 55-year-old woman received an intervention for colposacropexy 2 months before owing to severe hysterocele and cystocele and consulted for fever and intense lumbar pain. She was diagnosed as having L5 to S1 spondylodiscitis secondary to colposacropexy mesh infection. She received endovenous antibiotic treatment for 6 weeks and underwent a laparoscopic mesh excision to facilitate resolution of infection. Laparoscopic approach with a standard 4-port placement configuration was used, enabling the identification of the colposacropexy mesh. Surgical strategy initially consisted of dissection of the promontory, vesicovaginal, and pararectal spaces, having previously identified the main anatomic landmarks to preserve them. Suspension of the promontory peritoneum and the bladder to the abdominal wall enabled a better exposure of the surgical field, facilitating the dissection and excision of the mesh. Postoperative course was uneventful, and the patient was discharged 4 days later.

CONCLUSION

Owing to minimal morbidity and good results, laparoscopic mesh excision should be considered an effective treatment for spondylodiscitis secondary to mesh infection.