Laparoscopic sacrocolpopexy is regarded among the preferred methods of treatment for pelvic organ prolapse (POP). While vaginal surgery using mesh for POP treatment is getting more and more controversial, there is a sort of ease that surrounds laparoscopic sacrocolpopexy in terms of complications, which can concern not only the usage of mesh, but also the effect this type of correction has on the pelvic structures. An 80 year old woman presented in our clinic with acute urinary retention. The patient had undergone laparoscopic hysterectomy with vaginal sacrocolpopexy in the USA, 10 years previous to this presentation. The clinical exam revealed a massive enterocele with a grade IV rectocele, alongside an apical mesh erosion of 2/2 cm. Conservative treatment was attempted since the patient had multiple morbidities, but without succes. Surgical correction was then decided with sacrospinous fixation using a small polypropilene tape for the enterocele and a posterior bridge for the rectocele. Imediate postoperative result was satisfactory, but a surgical complication appeared, a ureterovaginal fistula which was conservatively treated in the urological department. While in the literature it is suggested that complications following laparoscopic sacrocolpopexy are rare, they can occur and the consequences may be severe. Reintervention may prove to be difficult and surgical complications can be expected. Considering that conservative treatment failed completely in this case and the trend is to refrain from using polypropilene mesh it is important to ask what would be an appropriate treatment for this kind of defects.
Corresponding Author: ENACHE T.|