Abdominal sacrocolpopexy (ASC) using polypropylene synthetic mesh is an effective and durable approach for the treatment of apical pelvic organ prolapse. Reported mesh erosion rates range between 0-10.5%.1,2 Conservative management with topical estrogen or transvaginal partial mesh excision can be successful in cases of limited mesh erosion or mild symptoms.3 However, an abdominal approach may be required for complete mesh excision in cases of extensive mesh erosion. We report our experience with transabdominal ASC mesh excision for complex mesh erosion.

A retrospective review was conducted to identify patients who underwent complete transabdominal ASC mesh excision at a community hospital from August 2020 and February 2024. Cases were included if the mesh removal was performed due to symptomatic mesh erosion. Complete mesh removal was performed via lower abdominal laparotomy and defined as excision of the sacrocolpopexy mesh in its entirety from the sacral promontory to the vaginal cuff or cervix. Surgeries were performed by a single female pelvic medicine and reconstructive urologist with assistance from a general surgeon as needed. A retrospective chart review was conducted to identify patient demographics, details of the prior sacrocolpopexy surgery, perioperative characteristics, complications, and short-term surgical outcomes. Results are presented as median (range) for continuous variables and n (%) for categorical variables.

Four patients who underwent complete sacrocolpopexy eroded mesh excision via an open abdominal approach were identified. Median age at the time of mesh excision was 62 years old (range 47-83). All four patients (100%) identified as Hispanic ethnicity. Median body mass index was 31.1 kg/m2 (range 23.4-33.9). The median time from index surgery to mesh excision was 71.5 months (range 50-128).

Symptoms of chronic pelvic pain, recurrent infections (vaginal or UTI), or vaginal discharge were present in 75% of patients. Three patients had their index surgery performed at an outside institution, one of which developed a pelvic abscess requiring exploration within a week of the index surgery. Two patients (50%) underwent at least one previous attempt of transvaginal mesh excision. Additional patient characteristics are shown in Table 1.

Severe adhesions between the mesh and sigmoid colon were identified in all cases and required extensive lysis of adhesions. Median operative time of mesh excision was 116.5 minutes (range 87-202). Repeat sacrocolpopexy using synthetic mesh was performed in one patient (25%). Median follow-up time was 6 months (range 1-15). No patients developed postoperative complications requiring additional surgery. All patients had resolution of pre-operative symptoms. One patient experienced worsened mixed urinary incontinence. None of the patients reported symptomatic, recurrent pelvic organ prolapse during follow-up.

Complete removal of complex eroded sacrocolpopexy mesh can be safely performed using an open abdominal approach with a low complication rate.

Transabdominal sacrocolpopexy mesh excision may be necessary in cases of large mesh erosion, persistent mesh exposure, recurrent infection, and vaginal discharge refractory to conservative management.3 Mesh erosion likely results from inflammation of the mesh, which can create dense adhesions and often requires complete excision to achieve symptom resolution. An open transabdominal approach may allow for complete excision of a complicated eroded sacrocolpopexy mesh with low complication rates. A multidisciplinary team approach should be considered in cases of extensive mesh erosion.

1.	Nassif J, Yadav GS, Orejuela FJ, et al. Rate of Mesh Erosion After Sacrocolpopexy With Concurrent Supracervical Compared With Total Hysterectomy: A Systematic Review and Meta-analysis. Obstetrics & Gynecology. 2022;140:412.
2.	Nygaard I, Brubaker L, Zyczynski HM, et al. Long-term Outcomes Following Abdominal Sacrocolpopexy for Pelvic Organ Prolapse. JAMA [Internet]. 2013;309.
3.	Bergersen A, Hinkel C, Funk J, et al. Management of vaginal mesh exposure: A systematic review. Arab J Urol. 2019;17:40–48.