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Vaginal Mesh Complications: Mesh Extrusion Treatment
Mesh extrusion refers to the mesh being exposed through the vaginal skin and is the most common complication encountered. This can occur with incontinence surgery (ie TVT, TOT, Mini-slings) or prolapse surgery done vaginally (vaginal mesh kits such as Prolift, Apogee/Perigee, Avaulta etc) or abdominally (mesh sacralcolpopexy). The exposure of mesh vaginally is considered a minor complication and typically treated very easily with a minor procedure. The exposure can occur secondary to the incision not healing completely over the mesh (a healing defect) or it can work its way through the skin over time secondary to the quality of the mesh or the quality and health of the vaginal skin itself. Infection, is typically NOT the cause of mesh exposure vaginally and therefore the entire mesh does not have to be removed. Only the small exposure treated.
If the exposure occurs during healing, treatment is typically initially conservative with the use of vaginal antibiotics and vaginal estrogen cream. If the skin does not heal over the exposure in 2-4 weeks, then it will need to be treated with a minor surgical procedure involving excising and trimming the exposed mesh and then closing the skin over the defect. This can sometimes be completed in the office and sometimes in the O.R. however is considered a minor procedure and can usually be done under local anesthesia or mild sedation. Cure rates are excellent and typically the exposure is very small and easily treated. Many doctors do attempt conservative treatment first, however if the exposure is not healing or the surgeon keeps doing small trimming in the office and it does not take care of the exposure….it needs to be treated definitively in the operating room by an experienced surgeon!
