title: The significant morbidity of removing pelvic mesh from multiple vaginal compartments.
abstract: OBJECTIVE
  To investigate perioperative complications of mesh removal performed in the operating room from a single-site, tertiary care center with a large volume of referrals for mesh removal and to compare the morbidity associated with single-compartment mesh removal compared with removal from multiple vaginal compartments.
  
  
  METHODS
  A retrospective review was performed on all patients who underwent mesh removal from January 2008 to April 2014. Patients were identified based on Current Procedural Terminology codes for removal of vaginal mesh or sling. Summary statistics were calculated for the patient population. Complications were compared between single-compartment mesh removal surgery and multicompartment mesh removal surgery. A P value of <.05 was considered significant for all analyses.
  
  
  RESULTS
  During a 75-month period, a total of 398 procedures were performed for the removal of vaginally placed mesh. A total of 326 (82%) patients underwent single-compartment surgery, 48 (12%) underwent multicompartment surgery, and in 26 (6%), the type of surgery was unclear. The indications for mesh removal included: pain (63%), dyspareunia (57%), mesh exposure (54%), and voiding dysfunction (39%). The mean length of mesh removed was 4 cm (standard deviation±2.8). Those with multicompartment surgery had approximately three times higher estimated blood loss compared with single-compartment surgery (P<.001). The odds of blood transfusion after multicompartment surgery were more than nine times higher than the odds of transfusion after a single-compartment surgery (odds ratio 9.7, 95% confidence interval 2.1-44.6; P<.01).
  
  
  CONCLUSIONS
  Bleeding complications are higher with concomitant removal of mesh from multiple vaginal compartments.
  
  
  METHODS
  III.
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Stephanie D
authors.initials: SD
authors.lastname: Pickett
authors.forename: Benjamin
authors.initials: B
authors.lastname: Barenberg
authors.forename: Lieschen H
authors.initials: LH
authors.lastname: Quiroz
authors.forename: S Abbas
authors.initials: SA
authors.lastname: Shobeiri
authors.forename: Dena E
authors.initials: DE
authors.lastname: O'Leary
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D020878:Device Removal / Q000009:adverse effects*; D004414:Dyspareunia / Q000209:etiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D011475:Prosthesis Failure / Q000009:adverse effects; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects; D014555:Urination Disorders / Q000209:etiology; D014621:Vagina / Q000601:surgery*