Sacral Osteomyelitis After Robotic Sacrocolpopexy

Feng, Tom; Thum, D. Joseph; Anger, Jennifer T.; Eilber, Karyn S.

doi:10.1097/spv.0000000000000219

Cited by 16 publications

(4 citation statements)

References 11 publications

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“…The anterior longitudinal ligament thickness over the promontory is only 1.9 mm where penetration of the periosteum is more likely to happen [ 19 ]. For the reason above, spondylodiscitis after sacrocolpopexy has been reported [ 14 , 20 , 21 ]. It is a rare but devastating complication for patients.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic pectopexy: the learning curve and comparison with laparoscopic sacrocolpopexy

et al. 2021

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Introduction and hypothesis In addition to laparoscopic sacrocolpopexy (LS), laparoscopic pectopexy (LP) is a novel surgical method for correcting apical prolapse. The descended cervix or vaginal vault is suspended with a synthetic mesh by fixing the bilateral mesh ends to the pectineal ligaments. This study was aimed at developing a learning curve for LP and to compare it with results with LS. Methods We started laparoscopic/robotic pectopexy in our department in August 2019. This retrospective study included the initial 18 consecutive women with apical prolapse receiving LP and another group undergoing LS (21 cases) performed by the same surgeon. The medical and video records were reviewed. Results The age was older in the LP group than in the LS group (65.2 vs 53.1 years). The operation time of LP group was significantly shorter than that of the LS group (182.9 ± 27.2 vs 256.2 ± 45.5 min, p < 0.001). The turning point of the LP learning curve was observed at the 12th case. No major complications such as bladder, ureteral, bowel injury or uncontrolled bleeding occurred in either group. Postoperative low back pain and defecation symptoms occurred exclusively in the LS group. During the follow-up period (mean 7.2 months in LP, 16.2 months in LS), none of the cases had recurrent apical prolapse. Conclusions Laparoscopic pectopexy is a feasible surgical method for apical prolapse, with a shorter operation time and less postoperative discomfort than LS. LP may overcome the steep learning curve of LS because the surgical field of LP is limited to the anterior pelvis and avoids encountering the critical organs.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic pectopexy: the learning curve and comparison with laparoscopic sacrocolpopexy

et al. 2021

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“…Data extraction from PubMed provided a total of 36 abstracts, and further reference search yielded additional 8 articles, gathering a total of 52 cases, 6 7 8 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 including ours. The summary of the results is presented in Tables 1 and 2 .…”

Section: Discussionmentioning

confidence: 99%

Conservative Management of Spondylodiscitis after Laparoscopic Sacral Colpopexy: A Case Report and Review of Literature

Tavares

Silva

Melo

et al. 2021

Rev Bras Ginecol Obstet

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Sacral colpopexy is one of the standard procedures to treat apical pelvic organ prolapse. In most cases, a synthetic mesh is used to facilitate the colposuspension. Spondylodiscitis is a rare but potentially serious complication that must be promptly diagnosed and treated, despite the lack of consensus in the management of this complication. We report one case of spondylodiscitis after a laparoscopic supracervical hysterectomy and sacral colpopexy treated conservatively. We also present a literature review regarding this rare complication. A conservative approach without mesh removal may be possible in selected patients (stable, with no vaginal lesions, mesh exposure or severe neurologic compromise). Hemocultures and culture of image-guided biopsies should be performed to direct antibiotic therapy. Conservative versus surgical treatment should be regularly weighted depending on clinical and analytical progression. A multidisciplinary team is of paramount importance in the follow-up of these patients.

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“…3,4,6 In one study, spondylodiscitis was found postoperatively in 5.6% of patients after laparoscopic sacrocolpopexy with concomitant rectopexy and in 0% of patients after laparoscopic sacrocolpopexy without rectopexy. 5 Some authors have even suggested that the graft rejection process could be an initiator or promotor of the inflammatory process in sacral bone after this procedure. 12 Combined surgical and antimicrobial therapy is the treatment of choice in most cases of spinal epidural abscess.…”

Section: Discussionmentioning

confidence: 99%

“…2 Spinal infection after abdominal or laparoscopic sacrocolpopexy is a rare complication. [3][4][5][6][7] The most common causative pathogen in spinal epidural abscess overall is Staphylococcus aureus (60%), whereas anaerobic microorganisms are only rarely found (2%). 8,9 Bacteroides spp are anaerobic, non-spore-forming, Gramnegative rods with a tendency of abscess formation.…”

Section: Introductionmentioning

confidence: 99%

Bacteroides fragilis sacral spondylodiscitis and epidural abscess after sacrocolpopexy: a case report and literature review

et al. 2019

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Spondylodiscitis with or without epidural abscess is a rare, although serious, complication after sacrocolpopexy. We present a case of an 81-year-old patient who developed anaerobic Bacteroides fragilis sacral spondylodiscitis with epidural abscess 18 weeks after laparoscopic sacrocolpopexy. Because of the patient’s old age, comorbidities, and further complications during hospitalization, she was treated conservatively with an early switch to oral antimicrobial therapy with good oral bioavailability. Because of retention of titanium bone anchors in the first sacral vertebra, oral antimicrobial treatment with biofilm-active clindamycin was prolonged to 6 months. This conservative approach was successful. One year after discontinuation of antimicrobial therapy, the patient had no signs of recurrence of infection or other complications. With retention of implanted material, we preserved good pelvic support with a good effect on the patient’s quality of life. A combined surgical and antimicrobial therapy with mesh removal is the treatment of choice in most cases of spinal infectious complications. However, we would like to emphasize the need for an individualized therapeutic approach in the growing population of frail and polymorbid, older patients, where a conservative approach can have important effects on the quality of life. Infectious complications can have devastating consequences in these patients.

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Sacral Osteomyelitis After Robotic Sacrocolpopexy

Cited by 16 publications

References 11 publications

Laparoscopic pectopexy: the learning curve and comparison with laparoscopic sacrocolpopexy

Laparoscopic pectopexy: the learning curve and comparison with laparoscopic sacrocolpopexy

Conservative Management of Spondylodiscitis after Laparoscopic Sacral Colpopexy: A Case Report and Review of Literature

Bacteroides fragilis sacral spondylodiscitis and epidural abscess after sacrocolpopexy: a case report and literature review

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