Analysis of Complications of Pelvic Mesh Excision Surgery Using the Clavien-Dindo Classification System

To describe and categorize complications in patients undergoing vaginal mesh excision surgery using the Clavien-Dindo classification system.

A retrospective review of 277 patients who underwent vaginal mesh extraction between 2007 and 2015 at a single institution was conducted with Institutional Review Board approval. Surgical complications were stratified using the Clavien-Dindo classification system. Complications were noted to be either peri-operative (prior to discharge) or post-operative (within 90 days). Indication for initial mesh placement, mesh revision procedure, time-to-resolution and medical comorbidities were assessed.

Of the 277 patients, 47.3% had at least one surgical complication, with 7.2% having multiple complications. A total of 155 complications were identified. The majority were grade II complications (49.0%), followed by grade I (25.8%), grade IIIb (18.7%), grade IIIa (5.2%) and grade IVa (1.3%). No Grade IVb or V complications were identified. Indication for initial mesh placement did not have a significant effect on complication frequency. Patients who underwent combined stress urinary incontinence and pelvic organ prolapse mesh revision surgeries had an increased frequency of complications compared to those undergoing mesh revision surgery for pelvic organ prolapse or stress urinary incontinence alone (p = 0.045). Most complications occurred post-operatively and resolved by 90 days. Age, body mass index, smoking status and diabetes were not associated with increased complications.

Despite the complexity of mesh revision surgery, most complications are minor. Serious complications do occur, emphasizing the need for proper patient counseling and surgical experience when performing these procedures.

The Journal of urology. 2017 Apr 19 [Epub ahead of print]

Goran Rac, Alyssa Greiman, Andrew Rabley, T J Tipton, Leah R Chiles, Drew A Freilich, Ross Rames, Lindsey Cox, Michelle Koski, Eric S Rovner

Department of Urology, Medical University of South Carolina, Charleston, SC., Urology of Kaiser Permanente Medical Center, San Diego, CA., Department of Urology, Medical University of South Carolina, Charleston, SC. Electronic address: .