title: What to Do With Recurrent Prolapse After Vaginal Mesh Failure?
abstract: OBJECTIVE
  To show that in selected cases laparoscopic sacrocolpopexy can be used for the treatment of recurrent pelvic organ prolapse after vaginal mesh surgery.
  
  
  METHODS
  Step-by-step examination of the technique using an educative video. Institutional review board approval was obtained.
  
  
  METHODS
  The authors describe two clinical cases of treatment of recurrent pelvic organ prolapse, after a vaginal mesh surgery, using laparoscopic sacrocolpopexy.
  
  
  METHODS
  A 56-year old patient (para 3, gravida 2) presented with the sentation of bulging in the vagina. On physical examination, the patient had a grade 2-3 vaginal apical prolapse and a stage 4 rectocele. She had a slight mesh contraction but no vaginal extrusion and no pain were reported. Eleven years before, she had a vaginal total hysterectomy for pelvic organ prolapse correction and one year before she had a vaginal prolapse repair using a synthetic mesh. A laparoscopic sacrocolpopexy with bilateral ooforectomy was performed. The second case is of a 54-year old patient (para 2, gravida 2) that presented stress urinary incontinence. On physical examination, the patient had a grade 3 uterine prolapse and grade 2 cystocele. Eleven years before she had a vaginal prolapse repair using a synthetic mesh and a miduretral sling for stress urinary incontinence. Two years before, she had the miduretal sling removed for recurrent urinary infections and dysuria. A laparoscopic sub-total hysterectomy with salpingectomy and ovarian conservation, sacrocolpopexy and a Burch colposuspension was performed.
  
  
  RESULTS
  The procedures and postoperative recovery were uneventful. No minor or major complications occurred. The patients were discharged three days after surgery.
  
  
  CONCLUSIONS
  Laparoscopic sacrocolpopexy is a promising approach for the treatment of recurrent pelvic organ prolapse after vaginal mesh surgery. It appears to be feasible, safe, and effective.
authors.affiliation: Department of Obstetrics and Gynecology, Centro Hospitalar Entre Douro e Vouga, EPE, Santa Maria da Feira, Portugal. Electronic address: paulanoris@gmail.com.
authors.forename: Paula
authors.initials: P
authors.lastname: Norinho de Oliveira
authors.affiliation: Department of Gynecological Surgery, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont Ferrand, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bourdel
authors.affiliation: Department of Gynecological Surgery, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont Ferrand, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Rabischong
authors.affiliation: Department of Gynecological Surgery, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont Ferrand, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Canis
authors.affiliation: Department of Gynecological Surgery, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont Ferrand, France.
authors.forename: Revaz
authors.initials: R
authors.lastname: Botchorishvili
mesh_terms: D052858:Cystocele / Q000601:surgery; D004868:Equipment Failure; D005240:Feasibility Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects* / Q000379:methods; D010535:Laparoscopy / Q000379:methods; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods; D056887:Pelvic Organ Prolapse / Q000473:pathology / Q000601:surgery*; D012445:Sacrococcygeal Region / Q000473:pathology; D058994:Salpingectomy; D013526:Surgical Mesh / Q000009:adverse effects; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000601:surgery; D014621:Vagina / Q000473:pathology*; D014623:Vaginal Diseases / Q000473:pathology / Q000601:surgery*
keywords: Laparoscopy; Mesh dissection; Sacrocolpopexy