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Vaginal cuff perforation during robotic‐assisted mesh recto‐sacrocolpopexy
Author(s) -
Chavez Jacqueline,
Finsterbusch Carlos,
Olson Craig,
Zimmern Philippe E
Publication year - 2020
Publication title -
iju case reports
Language(s) - English
Resource type - Journals
ISSN - 2577-171X
DOI - 10.1002/iju5.12138
Subject(s) - medicine , vaginal vault prolapse , surgery , vagina , cuff , vaginal vault , rectum , perforation , fibrous joint , dissection (medical) , surgical mesh , hernia , materials science , punching , metallurgy
We report on the management of intraoperative vaginal cuff perforation during robotic‐assisted mesh recto‐sacrocolpopexy for vaginal vault prolapse with defecatory dysfunction. Case presentation A 75‐year‐old woman with vaginal bulge and constipation was to undergo a joint robotic mesh recto‐sacrocolpopexy. Intraoperatively, mesh was secured to the left posterior vaginal wall following dissection. Prior to contralateral suture placement, the vaginal cuff split open and exposed an end‐to‐end anastomotic sizer previously inserted in the vagina. Due to subsequent mesh erosion risk, we proceeded with vaginotomy closure with running and interrupted absorbable sutures, removal of mesh, direct suture rectopexy to the promontory, and enterocele defect correction by reapproximating the right and left wings of the peritoneum flaps over the rectum with running sutures. Patient reported satisfactory outcomes after 2 years. Conclusion We reviewed our experience with vaginal cuff perforation during robotic‐assisted mesh recto‐sacrocolpopexy prompting enterocele repair and rectopexy without mesh.