Mesh Erosion After Abdominal Sacrocolpopexy NEERAJ KOHLI, MD, PEGGY M. WALSH, RN, TODD W. ROAT, AND MICKEY M. KARRAM, MD Objective: To report our experience with erosion of perma- nent suture or mesh material after abdominal sacrocol- popexy. Methods: A retrospective chart review was performed to identify patients who underwent sacrocolpopexy by the same surgeon over 8 years. Demographic data, operative notes, hospital records, and office charts were reviewed after sacrocolpopexy. Patients with erosion of either suture or mesh were treated initially with conservative therapy fol- lowed by surgical intervention as required. Results: Fifty-seven patients underwent sacrocolpopexy using synthetic mesh during the study period. The mean (range) postoperative follow-up was 19.9 (1.3–50) months. Seven patients (12%) had erosions after abdominal sacrocol- popexy with two suture erosions and five mesh erosions. Patients with suture erosion were asymptomatic compared with patients with mesh erosion, who presented with vagi- nal bleeding or discharge. The mean (  standard deviation) time to erosion was 14.0  7.7 (range 4 –24) months. Both patients with suture erosion were treated conservatively with estrogen cream. All five patients with mesh erosion required transvaginal removal of the mesh. Conclusion: Mesh erosion can follow abdominal sacrocol- popexy over a long time, and usually presents as vaginal bleeding or discharge. Although patients with suture ero- sion can be managed successfully with conservative treat- ment, patients with mesh erosion require surgical interven- tion. Transvaginal removal of the mesh with vaginal advancement appears to be an effective treatment in patients failing conservative management. (Obstet Gynecol 1998;92: 999 –1004. © 1998 by The American College of Obstetri- cians and Gynecologists.) The surgical correction of posthysterectomy vaginal vault eversion and complete uterovaginal prolapse pre- sents a challenging problem for gynecologic surgeons. More than 43 different operations are described in the literature 1 that use vaginal, abdominal, and laparo- scopic approaches, with variable results. Sacrocol- popexy, a widely accepted transabdominal procedure that suspends the vaginal vault to the anterior surface of the sacrum using natural or synthetic grafts, was first reported by Lane 2 in 1962. Since its introduction, the procedure has had many modifications of technique and graft material, but it results consistently in long- term cure rates in several large series. 3–5 The transab- dominal approach permits evaluation of the pelvis and abdomen, allowing concomitant operative procedures such as culdeplasty, retropubic colposuspension, and paravaginal repair. Abdominal sacrocolpopexy has been associated with complications including infection, postoperative ileus, severe hemorrhage, and injury to the bowel, bladder, or ureter. 6 Mesh erosion also has been reported as an uncommon complication after abdominal sacrocolpopexy when using synthetic mate- rial to suspend the prolapsed vaginal vault to the sacrum. Details regarding its incidence and manage- ment have not been described until recently. 7 Over the last 8 years, we noted a clinically significant incidence of synthetic mesh erosion after abdominal sacrocolpopexy. This retrospective study reviews our experience with abdominal sacrocolpopexy and suture or mesh erosion, and describes our management of this complication. Materials and Methods A computerized medical records search identified pa- tients who underwent sacrocolpopexy by the same surgeon over an 8-year period. The hospital records, intraoperative notes, and office charts were reviewed to collect data for each patient and to identify those with postoperative erosion of the synthetic mesh or perma- nent suture. Women had been evaluated preoperatively with a detailed history, physical examination, and cystometro- gram to exclude coexisting or potential urinary stress incontinence. Demographic data including age, parity, body mass index (BMI), estrogen and menopausal sta- tus, and smoking history were collected. From the Division of Urogynecology and Reconstructive Pelvic Surgery, Good Samaritan Hospital, University of Cincinnati School of Medicine, Cincinnati, Ohio. 999 VOL. 92, NO. 6, DECEMBER 1998 0029-7844/98/$19.00 PII S0029-7844(98)00330-5