Although it is not unusual to see a recurrent anterior or posterior wall defect after sacrocopalpexy, recurrent apical prolapse after sacrocopalpexy or sacrocervicalpexy is a rare phenomenon. This patient is a 53-year-old who underwent an uncomplicated LSH and sacrocervicalpexy for stage 2 prolapse at our center. She did well in the post-operative period until she re-presented over two years after surgery with symptoms of recurrent bulge and was found to have a stage 3 cervical prolapse with point C at plus 5 centimeters. Upon entry into the abdominal cavity, it was obvious that the lightweight polypropylene mesh was firmly adherent to the cervix and vaginal walls. We therefore anticipated finding a detachment of the mesh from the sacrum. To our surprise, the mesh appeared appropriately attached to the sacral promontory as well. It then became evident that the mesh had failed in the middle of the sacral extension, something we had never seen with this specific mesh since we began using it over four years ago. We decided to re-do the sacrocervicalpexy by attaching the two mesh segments with an intervening permanent polypropylene mesh. We often use the T-LIFT device to improve our exposure at the sacrum without the need for additional laparoscopic port sites. With such firm attachments to both the cervix and the sacrum, it did not seem sensible to dissect out the anterior longitudinal ligament or to remove mesh from that area. After identifying the right ureter, we began the procedure by opening the peritoneum over the sacral portion of the mesh, freeing up the end of the mesh and creating an opening in the peritoneum in order to re-peritonealize the mesh after the procedure was complete. We also freed up the distal end of the torn sacral mesh segment. The bladder was backfilled with 200 cc�s of dye-stained fluid and the bladder was dissected off the previous mesh and cervix. We also dissected in the rectovaginal space in order to assure ourselves that the rectum was free from the mesh. We further dissected the proximal sacral mesh tail, since we decided that this would be our attachment site for the new mesh. You can see in this video clip exactly where the mesh tore along the pelvic sidewall. A slightly heavier flat mesh segment was introduced and was sutured to the anterior vaginal wall and cervix with several interrupted Gore-Tex sutures. Keep in mind that this is the patient�s cervix and not just the vaginal wall, so our tissue bites can take considerable amount of tissue. All sutures were tied down using an extracorporeal knot tying technique using an open knot pusher. The mesh was then sutured to the sacral mesh remnant with two Gore-Tex interrupted sutures. Both sutures were placed before tie down, again using an extracorporeal knot tying technique. A third sacral suture was then placed before closing the peritoneum over the mesh. Reperitonealization was accomplished with a delayed absorbable barb suture completely burying the mesh under the peritoneum. Our patient later told us she had experienced significant constipation requiring a lot of Valsalva pushing at some point after her surgery, though she could not remember how long after surgery this had occurred. The patient was then placed in the operating room. This is an unusual case that demonstrates that lightweight meshes can potentially fail in the postoperative period. It has not, however, changed our use of this lightweight mesh since we have been very pleased with our results. It does, however, reinforce the point that we need to remind our patients to refrain from lifting and prevent constipation in the postoperative period when tissue ingrowth into the mesh is occurring.

recurrent apical prolapse

sacrocervicalpexy surgery

polypropylene mesh

stage 3 cervical prolapse

permanent polypropylene mesh